Pandemic preparedness, three years early

In a Q&A, team members behind the outbreak simulation PennDemic discuss how the exercise, now in its fourth iteration, equipped an interdisciplinary group of grad students for COVID-19 and beyond.

Students work at a table covered with paper, water bottles and markers. — Participants in the first PennDemic, which took place in 2018, lay out a timeline of the “outbreak.” Two additional simulations have since taken place, with one more scheduled for this coming fall.

When Penn Nursing Dean Antonia M. Villarruel and Professor Deborah Becker gave a 2018 presentation at Perry World House with Ambassador Bonnie Jenkins about the need for disaster preparedness, they had no idea just how prescient that talk—and the subsequent simulations they put on—would end up being.

“We knew we wanted to engage more people in training for these events so that if they happened, we would be better prepared,” says Becker, a practice professor of nursing and director of Penn’s Adult Gerontology Acute Care Nurse Practitioner Program. “We had no idea we were on the cusp of a worldwide pandemic.”

From that initial talk came three simulation situations, created with Jenkins, Shelley Rankin and Stephen Cole from Penn’s School of Veterinary Medicine, Hillary Nelson from the Perelman School of Medicine, and Cathy Poon of the University of the Sciences.

Two iterations focused on infectious disease outbreaks, the third on a natural disaster. There’s a fourth scheduled for this fall. Each exercise placed graduate students into interdisciplinary teams that included public health providers, basic scientists, veterinarians, pharmacists, physical therapists, nurses, physicians, and more to come up with solutions to the challenge at hand.

In Frontiers in Public Health, the researchers have published findings about the framework they created. Penn Today spoke with Becker, Nelson, and Cole about PennDemic, as well as how the experience equipped participants for the coronavirus pandemic of today and for future disasters.

For each PennDemic simulation, after you presented the scenario, what happened next?

Hillary Nelson: The very first activity is just in your discipline. That means you only talk about the information your discipline might receive. After that, you get into interdisciplinary groups, very purposefully, to come up with solutions. That is the crux of PennDemic: Rather than throwing everyone together at the beginning, we start them out in their own disciplines.

Deborah Becker: This shows them what each group brings to the table, but it also helps the quieter students or those who were less experienced feel like they could contribute and ask a lot of questions. Why don’t we know this information? Where do these disciplines get this information that we don’t get? Why is that? It can be very eye-opening.

Did anything in particular surprise you?

Becker: Veterinarians do so much more than I knew. It’s not only about caring for pets but also about the food chain, caring for livestock, and evaluating the safety of what we eat.

Nelson: For me, it was the pharmacists. We work with colleagues from the University of Sciences for the disciplines we don’t have at Penn, so there’s a nice synergy there. From that collaboration, we brought in pharmacy students. I had no idea how much pharmacists did beyond dispensing drugs.

In the paper you published about PennDemic, what findings did you detail?

Nelson: The question we’d hoped to answer was, Did this jigsaw framework that we developed have the pedagogical impact that we wanted? The answer was yes. We saw statistically significant increases in both working in interprofessional teams and in disaster and emergency preparedness. That was really the big picture. If you drill down a little more, to the qualitative answers, students were asking about why certain disciplines were missing. These graduate students—who are normally very siloed—understood that to truly tackle disasters and emergencies, you need an interdisciplinary team.

Stephen Cole: Beyond that, we also showed that this is a field where we can help to grow the workforce. We need a diverse group of individuals to enter this workforce as these issues become more prevalent. This is a route our students can take regardless of their profession. There’s room for a wide variety of experiences to be involved in these sorts of responses.

To that end, have you gotten a sense from previous participants that the simulations helped them prepare for COVID-19?

Becker: I ran into two students, one who did the first simulation, one who did the second. They said to me, ‘Did you know a pandemic was going to happen?’ Of course, we had no crystal ball. They told me that what we reviewed in our simulations was what they were seeing happening in the hospital with COVID. They’re both nurse practitioners, and it seems that being able to refer back to this experience helped them. It was only two people out of a hundred and some who have done this, but anecdotally we can say that they found value in it, particularly in terms of understanding what their roles might be during an actual pandemic.

Nelson: The third PennDemic simulation happened virtually this past fall. Those students definitely brought the experience of living through a pandemic into it. We haven’t yet done a follow up on the students who participated in the past few years, but that would be an interesting study to conduct.

How did the experience prepare participants for future pandemics and disasters?

Cole: Regardless of the scenario, our framework is all about building our students’ confidence. We take them from a setting they’re comfortable in within their own discipline to an interdisciplinary scenario where they’re maybe not as comfortable, but we’ve spent the time making them sure that they know what they know. So, this process helps to build interest and confidence working in teams, as well as in disaster preparedness and response. To me, that’s the real take-home.

Becker: When it comes to disasters, we always think about health and safety. We’ve got to make sure that people aren’t drowning, that they have water and food—which absolutely is important—but what about other facets like infrastructure? What happened with the building near Miami is an example of this. It’s not just about health, and that was really eye-opening for the participants. I think that might fuel their interest in this field.

Deborah Becker is a practice professor of nursing and director of the Adult Gerontology Acute Care Nurse Practitioner Program and Adult Oncology Specialty Certificate program at the University of Pennsylvania School of Nursing.

Stephen Cole is an assistant professor of clinical microbiology at the School of Veterinary Medicine at the University of Pennsylvania.

Hillary Nelson is an associate professor of biochemistry and biophysics in the Department of Biochemistry and Biophysics, director of the Master of Public Health program at the Perelman School of Medicine, and director of education for the Center for Public Health Initiatives at the University of Pennsylvania.