Town Hall: Transformations in teaching and learning

[Joe Guglielmo]
Welcome everybody to the weekly School of Pharmacy Town Hall. A few reminders before we get into the program. Your audio and video will be automatically muted. And it's only the panelists that can unmute themselves. The chat function is disabled. If you have questions, and you can ask those at any time, please use the Q&A feature at the bottom of your screen. As always, any outstanding questions will be answered in email. Or if not, or anonymous, we'll do it at the next town hall if possible, otherwise, we'll try to answer everything we can during this 30 minute Town Hall.

So I think you all know we're in our sixth full week of shelter at home. And I want to repeat what I say every week, and that is the school community is really a model in terms of its nimbleness, its adaptability, its collegiality, its problem solving. So I thank all of you for that. But I have to admit, and I think I'm speaking for all of you, it's getting a little old, it would be nice to occasionally see you in person and I'll get to that in a few minutes here. So as I also do, I want to make sure that we recognize this as a stressful time for a lot of people. And please reach out to others, managers, etc., if you need support, and take full advantage of all the UCSF emotional health resources on the COVID-19 website. Some of the examples there, you may note, include how to talk with children about COVID-19, how to maintain good sleep, there's a list of free workout and yoga videos. There's online stress reduction resources, just today or yesterday, in collaboration with the Department of Psychiatry and the Center for Digital Health Innovation, there is what's called COPE, which is a new program does for faculty, staff, and trainees to provide additional support to our valued colleagues who are experiencing anxiety, stress, and distress related to the COVID-19 pandemic, and its impact on their work and family life.

I'd like to do my usual statistical update that I do each week. I'm going to isolate really on the Bay Area and California and UCSF this time. So in California, there were, a week ago, 25,787 cases and 789 deaths. Today, the total of cases is up to 37,950. So a bump of about 12,000, which is about a 47% increase, but the death increase is up to 1447. So that increase in deaths is about 83% over what it was last week. Now it's just one week to the next. And statistically, I don't think you can say much about it. But it may have something to do with the increasing recognition of a second wave of the pandemic taking place in nursing homes and extended care facilities. And that may represent the increased number of deaths, relatives, and not quite as many increases in cases.

The usual University of Washington website used for projected peaks. Last week, they thought the peak would be April 19th. And they expected 52 deaths. And they thought the total number of deaths by August 4 was going to be 1483. Well, now, if you go to that site, they now project that the peak will be 1719, so about 300 or so more than they projected last week. But they do add an additional additional statement there. That's worth noting. And I quote them, “After May 18, relaxing social distancing may be possible with containment strategies that include testing, contact tracing, isolation, and limiting gathering size.” So I think you can pretty much bet on it. We're going to be following those specific strategies as we slowly move forward to coming back to work at UCSF.

The UCSF situation last week, there were 20 patients hospitalized at UCSF. Today at this moment, there are 14 patients in acute care so it's down. But unfortunately, it now includes our first child so far, and this is a two week old neonate who is at Benioff Children's Hospital in Oakland.

A few changes as relates to antibody testing for the diagnosis of disease. As of today, the UCSF Clinical Laboratory at the Parnassus campus will begin in-house testing for plasma antibodies. So this is the response to the infection, those that have had the infection should have an increase in what's called IGG antibodies. And the results will be available 24/7, and reported within one to four hours after receipt of sample. So it's a fairly quick survey. The study, if you want to know a little bit about it, it's an incredibly specific assay. And what I mean by that is, if you have it, it will find it, there's no doubt and it won't confuse it with any other infection it will know that it's this coronavirus. While it is incredibly specific, the sensitivity of this assay depends on when you were infected and when they draw the sample. So for example, if the sample of blood is drawn from 14 to 21 days after onset of symptoms, it's only about a 70% likelihood it will detect the IGG because it hasn't had enough chance to rise. In contrast, if you draw the sample like 21 days post symptoms, you can expect up to 99% likelihood it will find that you in fact have that antibody. So those are important.

The UCSF labs and actually UCSF as a whole have also said, Okay, so we have those, who should get it? and why would you get it? and I'll quote them. “The primary clinical use for this test would be to confirm infection in cases with high clinical suspicion, who have negative testing for the actual virus itself,” and that's the PCR piece. So in those patients with negative PCR testing and symptoms greater than seven days, they feel that is an appropriate time to use this test. The rest are investigational in their opinion, including identifying subjects predisposed to the virus for epidemiologic studies, or maybe seeing if certain individuals who have high titers can have their plasma used to actually treat infection. I'll quote the Infectious Diseases Society of America: "Until more evidence about protective immunity is available, these results should not be used to make staffing decisions, or decisions regarding the need for personal protective equipment."

This leads me to recovery planning, that last statement. UCSF continues to plan for a phased in approach to returning into work. Mark Freiburg, who's the executive director of Environmental Health and Safety, is leading that effort. I think I mentioned last week, but I'll say it again, there is a short term, a medium term, and a long term approach. Short term is from this point on through June. Medium term, we'll be developing a plan July through December. And long term we'll be starting January 2021 and on through the year.

You should be aware that as of yesterday, face coverings are now required in San Francisco and six Bay Area jurisdictions while outside. They must be worn when visiting an essential business and waiting for public transit or entering public places. They do not have to be medical grade. The CDC has a video on how to make a simple facemask if you're interested. Construction projects have resumed as of April 14, we hope that a number of the large projects will move forward allowing several of us to move into our new settings. And then lastly, to repeat, I said last week, the hiring freeze was announced two weeks ago and to repeat that will be all the way through June 2021. There is an exemption process that is possible. And the school now has a process to consider these exemptions. They must be critical and cannot be assessed through any other way.

So there were a couple outstanding questions from last week. One question for me was, quote unquote, do you think that there's a possibility that students won't graduate in 2021? The answer to that question for me would be if students at the UCSF School of Pharmacy will not be graduating 2021, no school of pharmacy in the United States is going to graduate their folks in 2021. I am very confident that we will be graduating students in 2021. I do not think there's a chance that it will not happen.

There were a number of questions for Marilyn Stebbins, who was our special guest at our last Town Hall and we were going to read those back, but in retrospect and reading them, for those of you that have not yet seen it, there's a very nice write up that Marilyn, working through Susie, have now put on the UCSF School of Pharmacy website. And I think virtually every question that was posed, you can find that there. So I'm going to pause at this point. And I don't know if there are any questions at this point, Eric. And just let me know if there are or not. If there are not, I'll pause. Are there any questions, Eric at this point?

[Eric Davila]
We have not had any general questions. yet. I did answer one person who asked if we post these later, because they missed the beginning. And that we do post these at pharm.ucsf.edu/covid-19. We do have one question if you want to go ahead.

[Joe Guglielmo]
Sure. I'll do that now.

[Eric Davila]
I'm asking for a friend, Are there N95 masks available for pharmacy students?

[Joe Guglielmo]
The short answer is not from the School of Pharmacy. In fact, if you were to ask for that from UCSF, you would not get one for all the obvious reasons. So apologies I can't give you a better answer than that.

[Eric Davila]
Is there a plan in place for lab reopening?

[Joe Guglielmo]
So that is part of this group that is moving forward. I will tell you that Lindsey Criswell, who's the Associate Vice Chancellor for Research at UCSF, they are developing a very detailed protocol on how in fact to do that, including everything from how to social distance, wearing of masks, thinking about staggering shifts when people come into the labs, and I will tell you that they're they're quite far along. I've seen the very detailed draft of that. I feel quite confident of using that as well as those from other institutions that are a little ahead of us like the University of Washington. So they are definitely moving ahead on that. I do not have those details other than the draft that Lindsey forwarded to me just two days ago.

[Eric Davila]
I think I've got one more, and another came in, can we start ordering lab supplies?

[Joe Guglielmo]
Can we start ordering lab supplies? I don't know. The best I can do on that one would be, I don't… Michael Norberg, are you able to answer that question? I don't know why you would not be able to order lab supplies. You want to try to answer that one?

[Michael Nordberg]
You could order, the question is getting them delivered to your lab if nobody's at the lab. I think that's the issue. So that would be contacting your department purchasing people to figure out how that would work.

[Joe Guglielmo]
Thank you. Alright, I think we're going to move on because we have a special guest today as well. And I think we're going to highlight OEIS, which in some respects, is the most impacted, or at least one of the most impacted if not the most, as a relates to this pandemic in terms of having to do things differently than we ever did before. And to that end, I'm going to have Vice Dean Sharon Youmans to say a word or two about the PharmD program, because some of you are not aware of, and what it was like before, and now what is it after COVID-19. And then I'll ask her to introduce our special guests from OEIS. So, Sharon, if you would, please take over.

[Sharon Youmans]
Thank you, Joe. And good afternoon, everyone. And I want to thank Joe and Susie for making this time to talk about education which is very important to all of us. As particularly, I'm pleased that we're going to be able to highlight the Office of Education Instructional Services, OEIS, whose main mission is to support the implementation and the delivery of our doctor of pharmacy curriculum. Those of you who are either on the end of delivering the curriculum curriculum specifically with faculty and residents and our volunteer faculty, and then those who are receiving the curriculum, which is our esteemed student body, OEIS plays an essential role in the success of us delivering this curriculum. The doctor pharmacy curriculum, our new curriculum that we implemented in July 2018, has a lot of complexity, a lot of moving parts, and with the advances of pharmacy education, as well as the advances of education technology, it was really critical that we have a trained professional staff who can help us in this enterprise. OEIS is composed of a talented group of young individuals, and I'll say young because I'm old enough to be their mother, who have training from being school teachers to having instructional design training, technology training. So we're really fortunate to have this unit to support us. Pre COVID-19, you know, we were delivering the curriculum, although it was new and our traditional way of having students in the classroom and small groups etc. and COVID-19 has totally turned that upside down. So on a turn of a dime, this unit had to make the curriculum accessible through remote with a lot of Zoom. It was not an easy task. They had just finished completing the legacy curriculum. So we've been winding down that curriculum for two years. And now they had to do a quick turnaround to make the curriculum accessible to our students so that we would not interrupt our education programs. So with that backdrop, they are going to share with you some of the changes that they've had to do and how this pandemic has impacted their work. They're probably busier than ever, but we're very grateful. So with that I'd like to introduce our interim director of OEIS, Cynthia Zarate, and her team and they will share sort of their experiences over the last six weeks. Cynthia.

[Cynthia Zarate]
Thank you Dean Joe and Vice Dean Youmans for having us and giving us this opportunity to share about the OEIS experience. Without a doubt the pandemic arrived and it transformed the delivery of education globally and the School of Pharmacy was not an exception. So prior to shifting to 100 percent, remote education access, we anticipated and prepared for some changes given the updates that we were receiving from our University leadership and local and state officials. For example, the week prior, we implemented social distancing measures with exam administration. So we were starting to get a little bit of a taste of what may be coming. However, we did not anticipate shifting to 100 percent remote access over a weekend. And that was exactly our reality on Sunday, March 15, six weeks ago to date. So during that Sunday, we grappled with many questions. How, how do we re-engineer the delivery of the curriculum? And two, can we do this? So that was what we were looking at that that Sunday. So our operational approach was to implement something nimble and intentional. And in a sense, it was a modified version of a plan, do, check, act model, a PDCA model, but it had to be very nimble because it couldn't be something that was bad. You know, that normal. So modifying and letting alone revamping organization workflow requires adding buffer time and learning and adjustment. But that was simply not an option here. So our guiding principle through this process had to include not only placing students and faculty at the center of our efforts, but the team. So the guiding principle was really having our team at the center. And the set this effort, we understood from the beginning would only be as successful as a team who was charged with the delivery. And with that, I would like to describe a little bit of a couple of truisms of the OEIS team. The first is their commitment to be of service. And the second is their resiliency. The team has demonstrated for the last two years with an organized operationalizing tool curriculums and a new curriculum, that they're really talented with evolving and adapting In the last six weeks, we have learned additional important lessons that we will continue to build upon. And I wanted to share some of those lessons with you before I pass it on to a couple of members of the team that will expand on these lessons. The first is nimbleness is a practice. We hear the word nimble, a lot being nimble, but it's a practice and we continue to practice it every day. Real time information flow was critical. We needed frequent, transparent, and honest communication, internally and externally. Collaboration and coordination for solutions across professional schools and partners such as the School of Medicine, the School of Dentistry, the library and ETS (Educational Technology Services) was key and is key as we continue to go through this pandemic. Team wellness sharing roles and responsibilities is essential as this is actually not a sprint, but it looks like it ultra marathon at this time and minimizing variables through anticipation. Additionally, we saw a strengthening of our interprofessional partnership with faculty as well. We have a lot of peer-to-peer teaching coordinator to faculty teaching and faculty to coordinator teaching. And that has that has been the key to being successful with implementing a lot of these new ways that we're implementing the curriculum. Teaching is still at the center as well. Lastly, we needed to really maximize our existing resources, our learning management systems such as Ilios, and our assessment platform such as ExamSoft, we were using them at a certain baseline, but now it's about getting more resourceful and maximizing how we can actually use them at different levels. So the vignettes that you will hear from Stephen Brewer, Alexa Tan, and James Ferguson will shed light on some of these, they'll give you some stories and illustrate some of these lessons learned. And I'd like to introduce Stephen Breuer, interim manager of data and technology, who will get us through our first vignette. Thank you.

[Stephen Bruer]
Thanks, Cynthia. So I'll start off by saying this has been an absolutely tremendous experience. And I've been nothing but impressed by our team and faculty have really stepped up to the challenge. So, as most of you know, nearly 100% of our curriculum was previously delivered in person. And anyone that has worked with our team knows that we coordinate a ton of larger obsessions, conferences, workshops, exams, and OSCEs (Objective Structured Clinical Exams) every week, and that we've built a lot of workflows and support services for delivering all of these things in person. So with the pandemic, we had to pivot 100% to remote learning. That happened really fast. And we had to instantly re-engineer every one of our approaches to fit this new paradigm. Our team really stepped up to this challenge. I think part of this was that we had just went through building this new transformation curriculum. And our team has really been in this mindset of adaptability, flexibility, and creative thinking. So when we got word way back on that Sunday in March, seems like a year ago now, OEIS knew immediately that Zoom was going to be the backbone of delivering the curriculum. Everyone knows Zoom, we use Zoom every day for meetings. But what you probably don't know is that Zoom has a ton of different user types, different levels of permissions, different ways of managing user groups, and each individual personal account has variability where you can set about 70 different settings, according to how you'd like to use Zoom. Additionally, our specific instance of Zoom has been set up for HIPAA compliance and a lot of different things, feature sets are limited. So we had to work through what all those matters. And the best way to optimize settings for instruction. And we were able to do that with collaboration with our IT partners in a weekend, which is still ... I'm completely impressed by how smooth it all went and the speed at which we moved. I think partnership between our team and faculty was also really essential. Our coordinator stepped up but so did our faculty in really redesigning and rethinking how we do things with Zoom. That included becoming complete Zoom experts in a matter of a week, building out the new roles that our staff took on these individual sessions every day, recreating all the schedules, re-communicating how we're going to conduct business with all of our faculty, that included reaching out one-on-one to all of our volunteer faculty who were scheduled over the next couple months. There's a lot of one on one trainings, especially early on, testing out different features like breakout rooms, even basics like screen sharing, working through audio issues, making sure that everybody had user accounts across all of our faculty and students, working with our partners, such as Education Technology Services, in figuring out how do we manage lecture recordings now, something that was completely automated before. It's been, again, a tremendous experience and really looking forward to how we continue to leverage this technology. Going into the next theme. And with that, I'll hand this over to Alexa Tan, who is going to be discussing exactly how we approach assessments.

[Alexa Tan]
Thank you, Steven. Um, so remote education in particular faces a challenge. of conducting assessments and ensuring exam integrity from a distance. As a result, different questions emerge, you know, how can we maintain edge an educational continuity for both our students and faculty? How can we protect and ensure exam integrity? Many are new to remote learning in remote assessments raises the stakes for our team, students and faculty, and presents us with a very special challenge. So while there is no silver bullet that can be equipped to quickly solve all our needs, the success of our team's ability to rise to this challenge and to adapt to changing circumstances is anchored in the very tenants that our SOP curriculum was built on, which is using critical thinking, problem solving and challenging the norm. So to administer assessments remotely, we've leveraged our current technology and readapted our systems and platforms in a whole new way that has pushed the boundaries to meet our new and emerging needs. In partnership with faculty, we is has currently administered about 10 remote exam during this short turnaround time, which started around the end of March to now. On April 7, the first remote OSCE was conducted live using both Zoom and ExamSoft. So a high stakes process that's primarily been done in person was successfully executed with, with the support of our skills faculty and OESI team. On April 16, we successfully piloted a three hour exam with remote proctoring. To prepare our students, we issued a mock exam to simulate the exam process and held the Zoom Q&A session to be clear and transparent with our expectations. So combined, the core of our ability to be inventive and adapt quickly lies in our team's ability to adopt the hands on approach in prototyping and testing in an iterative process. And more critically, our team saw this opportunity to find a way to apply the scientific way of thinking and method of experimentation into our solution process. This in turn allowed us to leverage and expand the potential of our current assessment platform. So being open, adaptable and responsive to feedback and strengthening the cross collaboration across faculty, students and staff has shown to be a significant step in the right direction to meet this challenge head on. So with that, I'll now segue to James Ferguson, who can provide some insight into how the experiential team has created creatively approached their unique challenges.

[James Ferguson]
Thanks Alexa, in the world of APPE (Advanced Pharmacy Practice Experiences) are scheduled for the overlap year were finalized in early January. However, as the effects of the pandemic became clearer, and partner hospital systems and sites began to cancel student rotations, the decision was made to cancel the first APPE block for the class of 2021 and adjust the number of APPE rotations from eight to six. This necessitated restructuring all 220 plus students schedules and essentially redoing much of the work that had been done earlier in the year. Working very closely with faculty, we spent hours changing the students schedules, adjusting rotation definitions and ensuring that new evaluation assignments are set up correctly. Each change to a student's schedule would result in a cascade effect throughout the master schedule. This made schedule adjustments a very time consuming process, requiring a lot of patience and concentration to look for novel solutions. Once the schedule changes were determined they needed to be individually entered into E*Value so the changes could be properly tracked and recorded. And now with our APPE schedule set, we're moving on to tackle the COVID related effects on student IPPE rotations, both in the world of community and hospital-based rotations. So now I'd like to send things back to Cynthia for some final thoughts.

[Cynthia Zarate]
I just want to take this opportunity to thank the entire team that's listening as well. And also to thank all the faculty and the university leadership and without all your support, we wouldn't be able to do this. So thank you.

[Joe Guglielmo]
Thank you, Cynthia, Stephen, Alexa and James and my gosh, the words nimble, resilient, problem solving, challenging the norm. It was music to my ears. And actually you guys have demonstrated that every day. There is no group that pivoted like you folks did. So thank you for this wonderful presentation. So I think we're pretty much at time, but I'm happy to take some more questions if there are any. Eric.

Eric Davila
There are there are a few. One related to the topic. Is there any updates on whether classes will restart over the summer? Or will full remote learning continue through summer and fall?

[Joe Guglielmo]
I think I'm gonna ask Sharon to answer that she knows that answer. So go ahead, Sharon.

[Sharon Youmans]
Yes, so we are in remote access through June 5. The campus education deans are discussing that now and more than likely, we will still be in the same remote delivery of the curriculum for the near future. Specific dates will come out soon. But we can pretty much count on that.

[Joe Guglielmo]
Question, Eric.

Eric Davila
We have about four total. I don't think we can do them all in the time allotted. There's another one for OEIS though. Do they have any ideas about how a virtual internship could be organized?

[Joe Guglielmo]
Wow. I see I see blank looks all the way across the screen.

[Sharon Youmans]
internship.

[Joe Guglielmo]
It's a good question.

[Sharon Youmans]
We won't count it out. You never know.

[Joe Guglielmo]
All right, we probably should call it or two minutes over. So again, thank you, Cynthia and team that was a fantastic presentation. We are proud of each and every one of you. Thanks for all your efforts in the meeting. Time everybody. Stay well and stay physically, mentally, emotionally well. Take care.