Reflecting on Teaching amid a Pandemic

In February 2022, I wrote brief reflections on my second year on the tenure track. It has been 2 months since, and I have more thoughts about teaching. Not only teaching, but teaching during a pandemic. It’s easy to forget, but I’ve only ever taught at the university level in the context of a pandemic, so my experience has been unorthodox, and my expectations never matched the pre-pandemic “normal.”

Image Description: Photo of a brown-skinned Black woman in a black dress, with black framed glasses posed outdoors in front of a sign that reads, “MacGavran Greenberg Hall; Gillings School of Global Public Health”. Her expression is neutral, and she is gazing directly at the camera.

I began the Spring 2022 semester with the expectation of teaching in the classroom. However, seeing the Omicron wave, I requested a switch to a remote option, in order to reduce the risk of transmitting SARS-CoV-2. This was especially pertinent, because there were early reports of people not testing positive on antigen rapid tests until well after the onset of symptoms- meaning that they were infectious before the infection was detected. And later, we would learn that people could remain infectious until well after the 5-10 day isolation period recommended by the Centers for Disease Control (and Prevention) at the end of December 2021.

Anyway, days after my request for a switch to remote instruction was approved, the entire School switched to remote instruction for the beginning of the Spring semester. Functionally, this meant that I had to overhaul the course that I had originally designed and submitted for approval in Fall 2020. Overhauling HPM 756 (Conceptualizing & Measuring Health Care Access) meant that I had to redesign the assignments (GIS labs), in-class activities (reading discussions) to be accessible and engaging in the context of remote instruction. The first 2 weeks of the class were ROUGH, because my syllabus was riddled with errors that I couldn’t spot in time (mind you, the syllabus template is 25 pages long). The errors included incorrect due dates, incorrect class dates (I forgot about the religious holidays), and omitted details about the final project.

Thankfully, the students in my class were (and are!) patient and understanding. We were entering the 3rd year of this pandemic, and we were all tired. I tried to extend that same grace, with flexibility in assignment submissions, waived late penalties, and reduced workloads. I even said, “my class is not the most important thing in your life, and that’s to be expected.”

Nonetheless, teaching has been really fun. The first few weeks had their learning curve, because I had to figure out how I could create an engaging course in 75-minute increments. My lectures typically have a narrative format. I more or less memorize my lectures, and the slides are designed to be accessible. I have bulleted points with the key points, and I use call-out boxes for the references that I’ve cited along the way. This enables learners to go back to the lecture slides and recordings and retrace their thought processes. On reading discussion days, I try to start with a brief recap and open the floor to questions about the course content thus far, before diving into the reading discussion. The reading discussions are typically framed around paired readings that highlight theoretical and methodological considerations for measurement in health services research (HSR), with a focus on health care access.

Example of a slide from my lectures. On the left is a map showing the Medicaid Expansion status of the U.S. states as of January 2021. On the right is a text box, with an excerpt of an article, which reads, “South Carolina has limited care for its diabetic residents, refusing about a decade ago to expand its Medicaid program under the Affordable Care Act. Additionally, visits to podiatrists, who monitor and treat diabetics’ feet and legs, were no longer covered by the program, creating a never-calculated increase in vascular consequences.” This quote and map were paired in the context of a discussion of inequities in healthcare access and quality, and the downstream consequences of these inequities.

The GIS lab exercises were harder to pull off. Because I was accustomed to teaching in a lab format, I expected a computer lab where all computers have the same operating system, etc. Instead, I learned that 1) the classroom I was assigned was a typical classroom, and not a computer lab, and 2) the course would be remote anyway. This meant that I had to redesign my GIS labs so that they could be done on personal computers with different operating systems, with minimal error or trouble-shooting. If you have exposure to GIS, you know that this is hard to pull off, and the learning curve for GIS is steep.

So, I pivoted to labs that were more focused on applied spatial analysis using “real-world” datasets, rather than mapping (because mapping is not all that geographers do). Learners in my Department (MSPH and PhD degree programs in Health Policy and Management) typically have prior exposure to non-spatial statistical methods, so I used that as a scaffold for my teaching on spatial analytic methods. We covered a broad range of spatial analytic methods (e.g. 2-Step Floating Catchment Area (2SFCA) methods and their variants, spatial regression models, spatial clustering analyses), in tandem with case studies from the HSR literature. This was paired with theoretical discussions about the underlying assumptions of these methods, and whether they were well-matched with the phenomena of interest and/or the data used to study said phenomena. The aim was to teach spatial thinking along with a more holistic approach to matching methods with theory with data, rather than being led by the data.

Another example of a lecture slide from my class. The slide is entitled, “Case Study: ICU Beds in FL Amid COVID-19.” On the left side, the slide features 2 2-paneled maps of Florida, showing location and accessibility of Intensive Care Unit (ICU) beds across the state. The text to the right of the map reads, “Results revealed that many areas in the northwest and southern Florida have lower access compared to other locations. The residents in central Florida (e.g., Tampa and Orlando cities) had the highest level of accessibility given their higher access ratios. We also observed that the 2SFCA method overestimates the accessibility in the areas with a lower number of ICU beds due to the “equal access” assumption of the population within the catchment area.”

All told, the course turned out to be a hybrid of a methods and subject matter/survey course, which started with an overview of conceptual frameworks and models of access used in HSR, followed by a several weeks-long module on the principles of spatial data management and analysis (including a survey of spatial analytic methods used by health and medical geographers who study healthcare systems and outcomes). The final part of the course was more focused on applying methods and working through case studies to understand the strengths and limitations of those methods across different contexts or outcomes. We discussed topics like measuring spatialized exposures that contribute to poorer health outcomes (e.g. racial segregation; environmental racism), adverse outcomes borne of inequities in care access and quality (e.g. racial disparities in diabetic amputations among Medicaid beneficiaries; birth outcomes and maternal morbidity and mortality among BIPOC birthing people), and rehospitalizations in the context of home health models and healthcare policies aimed at reducing readmissions among Medicare and Medicaid beneficiaries. The discussions were robust and fruitful, in part because of the composition of the class. My class drew students across the School of Public Health, the School of Medicine, and even Departments in the social sciences. Not only that, but we benefited from the wealth of experiences, such as healthcare administration, health insurance plan design, etc. This meant that the discussions were enriched by that diversity.

Was teaching hard? Yes. Absolutely. It took up all of the time and energy that I gave it, and I’ll be scrambling to catch up on research once the semester ends.

Was the effort worthwhile? Absolutely. Without a doubt.

Well, that’s all for now. In case you missed it, you can find my reflections on Year 1 on the Tenure Track here.

All my best,

A

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