HJAR Sep/Oct 2022

DIALOGUE 12 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF ARKANSAS   would otherwise typically have been able to obtain, and which the pandemic put an end to. Most hospitals didn’t allow individu- als to volunteer during the pandemic, so for people wanting to go into medical school, that really limited the ability to do what we call shadowing or other clinical preceptor experiences. I think there are some folks that have delayed applications to the med- ical school to be able to get those experi- ences, to be sure that this is really what they want to do. Editor You have the ear right now of the Arkansas healthcare industry, and many are concerned medical/nursing students/ residents who have experienced signifi- cant interruptions to their training dur- ing the pandemic. As the pandemic raged, important hands-on training was dimin- ished. “It is one thing to watch,” they say, “another to do.” Is that a valid concern? Smyth There was some slowing of training, but we were pretty quickly able to get our medical students the clinical experiences that they needed. Last summer, we noticed that some of the students coming into their clinical rotations were not quite where their previous classmates had been, but within a couple of months, they got back up to speed. We were very fortunate. We have a phenom- enal sim center, and we were able to do a lot of things virtually and with simulation. I really think that any of the delays were fairly transient and that certainly by the time the students graduated, they had the skills that they needed to be physicians. Now, hopefully, we have processes in place that are really allowing them to have a full medi- cal school experience. Editor What are some of those adaptations and teaching and training methods that you’ve had to implement? Smyth We certainly are using a lot more virtual platforms and combining virtual platforms with active learning. Something we’re particularly proud of in the college has been our transition to active learning over the last five or so years and incorpo- rating that into virtual learning experiences as opposed to the standard classroom lec- ture that would be relatively easy to offer via Zoom or another remote digital platform but is not as effective for adult learning. And really, using technologies to promote active learning has been something that I think we certainly are nowmuch better positioned to do, along, as I said, with a lot of simulation/ virtual reality. The technology that exists now is just mind-blowing — what you can teach and show and learn through digital technolo- gies. We’re able to basically give 3D recon- structions of anatomic and pathologic con- ditions. Every time I look at some of the virtual technologies that are out there, it’s extraordinary. And, of course, all of that can be delivered. Editor Aside from technology and the pan- demic, if that’s possible, how is training an MD different today than it was, say, 10 years ago? Smyth That’s a very important question, and I’m going to tie it into not just where we are now, but really where we need to go, because I think that medical school education is a work in evolution, in prog- ress. We do a much better job of training around teamwork and social determinants of health, thinking much more holistically about approaches to not just medical dis- eases and conditions, but how to keep peo- ple healthy. And, moving forward, we need to do an even better job. If we think about where we want to be in terms of achieving health equity, it really is going to start with our approaches in medical school. We are always going to have to, as physi- cians, know how to treat individual patients and how to manage disease. We need to go beyond that to understand how we keep communities healthy, what the determi- nants of health and disease are for com- munities, how we as physicians advo- cate, and how we work together with our communities and individuals across all different aspects of the healthcare profes- sions to accomplish that goal. There’s still a lot of fundamental work that needs to be done, and it also needs to tie into our efforts around being a more diverse profession and having a more inclusive work environment as a profession. Editor You’re an academic. How would you grade the status of the overall health of Arkansas? Smyth Certainly, when you look at chronic conditions and how we fare across Arkan- sas, one of the most staggering things to me is the difference in life expectancy between the counties with the highest life expectancy and those with the lowest, and that reflects healthcare disparities in rural communities. It’s true across the United States. Those are where the largest disparities in health are — in rural communities and particularly in persistent poverty areas and underserved communities. To me, that’s really where the work and the opportunity lies for Arkansas — to think about howwe as a state can really lead the nation in addressing those ineq- uities and lowering that gap of life expec- tancy. We want all of our counties to have a life expectancy that we see in our healthiest counties today. Editor How about grading the over- all health of the healthcare industry in Arkansas? Smyth I think we have a robust healthcare system. We have a blend of everything from private practice groups in communities to independent hospitals and hospitals that are part of systems. We have challenges inmak- ing sure that we have the right healthcare. And this is true across the United States, not just in Arkansas. We have challenges with making sure that we have the right num- bers of and the right types of healthcare professionals serving all of our different regions of the state. That said, I think that by mobilizing what exists and the existing