USF Health students, staff and faculty during a White Coats 4 Black Lives demonstration outside of the USF Health Morsani Center, in June 2020.

In December 2020, Susan Moore, MD, an Indiana physician, died of COVID-19 after alleging she experienced racial discrimination while undergoing treatment at a hospital operated by Indiana University Health System. “Moore’s story of her pain being dismissed reinforces what studies have repeatedly shown: Even taking wealth, education and insurance status into account, Black patients receive worse medical care and face worse outcomes,” a Washington Post article on Dr. Moore’s death said.

Just one month before Dr. Moore’s death, the Association of American Medical Colleges (AAMC) shared an article that touched on a 2016 study published in the Proceedings of the National Academies of Science which included a survey that revealed that 40% of first- and second-year medical students endorsed the belief that “Black people’s skin is thicker than white people’s.” The study also showed that the trainees who believed this myth were less likely to treat Black people’s pain appropriately.

This article brought to light the continued need for institutions to address racial bias in healthcare starting with health education. USF Health is doing its part by building curriculums that teach the next generation of health care providers about social determinants of health and how to provide value-based and patient-centered care, and recruiting and retaining the diverse educators to teach it.

“Your goal as the practitioner is to truly understand who the patient is and all of the different aspects of the patient which may have some impact on their medical care,” Deborah DeWaay, MD, FACP, associate dean of undergraduate medical education for USF Health Morsani College of Medicine (MCOM), said. “It helps the provider battle unconscious bias because when they individuate patients in their mind, they’re less likely to give biased care.”

In 2016, MCOM started focusing on incorporating course objectives that examine prejudice, assumptions and privilege, such as Safe Zone training and poverty simulation activities. In 2019, Shirley Smith, MA, director of student diversity and enrichment for MCOM, became the College’s integration director for cultural competency. Using the AAMC’s objectives for cultural competency, Smith spent hundreds of hours reviewing the entire MCOM curriculum, and will continue to do so on an annual basis, highlighting places where the objectives were not being met to the highest level. These findings were then presented to the curriculum committee who make the final decision about changes to curriculum and if approved, provide recommendations for moving forward. In addition, Smith provided feedback to faculty about where there may be bias within the didactics. “It’s been really refreshing to have faculty embrace this and leadership like Dr. Lockwood, support this,” Smith said. Students also have the ability to provide real-time feedback to Smith and her team via an anonymous survey. “What we’re really trying to do is not have any judgement attached to the feedback,” Dr. DeWaay said. “We’re trying to create a method for our faculty who are teaching, to deal with their unconscious bias in a safe environment.”

USF College of Public Health Dean Donna Petersen, participating in the 2019 poverty simulation along with other USF Health deans, faculty, staff and students. Pre-Covid Photo.

MCOM is also in the process of partnering with Wake Forest University in North Carolina to create curriculum that can be used at both universities in order to maximize resources and reach more people. This material will become a curricular thread integrated across all four years of medical school which USF MCOM calls Humanism in Action. Smith quoted Bryan Bognar, MD, MPH, vice dean of MCOM educational affairs, when she explained that the important part of this effort is to make sure that they’re “baking things in” and that the curriculum is “not an à la cart menu.” The curriculum teaches students the communication skills necessary to elicit the values of their patients and then integrate those values into the patient’s medical plan. “It’s physically impossible in four years to teach students every single nuance about all the ways a human being or population can be different,” Dr. DeWaay said. “It’s far more important to teach the attitude that they need, the skills to illicit the information from the patient and the skills to keep up on the literature, so that they have the tools that they need moving forward, to take care of any patient that’s in front of them.” According to Smith, the objective is to teach students not to assume anything about their patient, not to project their own values onto the patient and not to deviate from what is fact or what is in the evidence. Janet Roman, DNP, APRN, ACNP-BC, director of the Doctor of Nursing Practice (DNP) program in the USF Health College of Nursing (CON), added that it’s not just about what question is asked, but about how it is asked. The way a question is worded can be loaded with an assumption and be offensive to the patient. “If you ask me, “Do I have access to healthy food?” now you’re assuming that I don’t,” Dr. Roman said. “If you ask me, “Where do I get my groceries?” then that gives you the answer.”

A taskforce is also being formed to include faculty and students who will help build and implement this new Humanism in Action curriculum and be a resource to faculty for recommendations or feedback on revamping lectures, small groups and activities. One component of change cultivated by the COVID-19 pandemic is the acceptance of virtual guest speakers and virtual learning by students and educators. This will allow for a more diverse representation of speakers to be a part of the courses as well as private, small group activities that can foster more vulnerable discussions. “These beliefs have to be socially unwoven through intentional, meaningful conversations and interactions with depth and the goal is to give students that opportunity,” Smith said. “I’m just planting seeds. I may never see the tree, but I must believe that the possibility is there.”

In January 2020, MCOM earned recognition from the Alpha Omega Alpha (AOA) Honor Medical Society for their dedication to diversity and understanding in various patient populations. The medical school was one of two medical schools in Florida to receive an Award for Excellence in Inclusion, Diversity and Equity in Medical Education and Patient Care. The award recognizes medical schools, and their associated AOA chapters, that demonstrate exemplary leadership, innovation, and engagement in fostering an inclusive culture that transforms the ideas of inclusion, diversity and equity into successful programs that support student, staff and faculty diversity in service to the community.

After the murder of George Floyd in May 2020, students pleaded for a call to action for faster implementation of changes to the curriculum. “The morbidity and mortality that social determinants of health, systemic racism, and health care disparities have cost people living in this country, far surpasses the toll COVID will take, and yet we’re not tackling it with the same resources,” Dr. DeWaay said. “With COVID hitting, it shows us on a local, regional and national level, what we’re capable of doing when we’re really worried about something.” Fueled by the same passion as the students who have championed these efforts from the very beginning, Smith and Dr. DeWaay returned to the curriculum committee and presented a 15-point, call to action. The committee mandated the plan in June 2020.

Dr. Deborah DeWaay (center), associate dean of undergraduate medical education for USF Health Morsani College of Medicine, with medical students. Pre-Covid Photo.

According to the Center for Disease Control and Prevention (CDC), there is increasing evidence that Black, Indigenous and Latinx communities are suffering disproportionately from COVID-19. This is the kind of information that can spark a myth about minorities if the root of the cause is misunderstood. Black Americans are infected with COVID-19 at nearly three times the rate of white Americans and are twice as likely to die from the virus, according to a report from the National Urban League based on data from Johns Hopkins University. This is not because of any biological differences between the two groups, but instead, social determinants of health and systemic racism. This is evident in the report which shows that Blacks are more likely to have preexisting conditions that predispose them to COVID-19 infection, less likely to have health insurance, and more likely to work in jobs that do not accommodate remote work. “Your zip code may be the biggest determinate of your health outcome more than anything else,” Kevin Sneed, PharmD, dean of the USF Health Taneja College of Pharmacy (TCOP), said.

Understanding these social determinants of health is instrumental in dispelling myths and providing patient-centered care and is another key component of USF Health education. Social determinants of health are conditions in the places where people live, learn, work and play that affects a wide range of health and quality-of life-risks and outcomes. Factors can include a person’s education, financial literacy, discrimination, and access to healthy food and safe places to exercise. Students in the USF Health College of Nursing learn about disease processes such as heart failure, hypertension and diabetes, and at the same time, “we want to point out to students which populations are disproportionately affected and then give them that background on why, so that we can help close that health disparity gap,” Dr. Roman said.

According to Dr. Sneed, one of the most meaningful courses offered at the Taneja College of Pharmacy, one that has been a requirement for first-years ever since the inaugural class of 2011, is the introduction to public health course. The course was developed by the USF Health College of Public Health (COPH), continues to have input from their faculty, and mainly focuses on social determinants of health. “You spotlight that in a course and then when you give the demographics of what that means for these various communities, it really does help broaden the expanse of how people view communities of color and why we do things like Bridge Clinic and Tampa Bay Street Medicine,” Dr. Sneed said. “We’re going to have to push to a different level of comfort, maybe even discomfort for many people in order for it to really take hold.”

A pharmacist has a unique place in the community. “Not everybody has a physician or has health insurance, but anybody can go to CVS and say, “my child has a fever,” Tricia Penniecook, MD, MPH, vice dean for education and faculty affairs for COPH, said. The patient benefits if the pharmacist has a public health world view and can help make decisions that are best for the patient’s situation.

USF College of Pharmacy Dean Kevin Sneed, PharmD, and Tricia Penniecook, MD, MPH, vice dean for education, participating in a Voices in Leadership panel discussion during USF Health Multicultural Week in 2019. Pre-Covid photo.

While colleges of medicine, nursing and pharmacy focus on helping patients where they are downstream, sick that day, public health looks upstream and tries to address what has happened to bring them to that point. Instead of individual-based care, public health professionals look at the care of groups of people in the population and find and fill gaps in their access to health care or the conditions for people to be healthy. That’s why interprofessional education is a critical part of USF Health because both kinds of roles are important. “As part of the discipline of public health, you’re supposed to take care of those who are at a disadvantage,” Dr. Penniecook, said. “The structures and systems in this country have put certain populations immediately at a disadvantage just because of that’s who they are when they are born.”

An integral part of every accredited college of public health in the United States is making sure that students learn about health inequities that are based on disparities. At USF Health’s COPH, students not only have courses specifically on health inequities, but the topic is addressed in every public health course from the undergraduate to the graduate level. Having this thread at every level means that students learn what the basis of those health inequities are, what they look like and how to address them no matter where their career takes them. According to Dr. Penniecook, this means that if the student is going to be working in the community, they’ve learned about community education and teaching people about self-advocacy in the healthcare system; if the student is going to be working within the system, they’ve learned about how to measure and address health inequities; or if the student is going to have a leadership role, they’ve learned about being proactive in looking for ways to solve the health inequities such as policy development.

Prior to COVID-19, COPH started working on an academic master plan. Dr. Penniecook, described an academic master plan as a road map within the strategic initiatives of the institution, that tells you what you need to do academically to get to your goals. In response to the murder of George Floyd, Dr. Penniecook asked Donna Petersen, ScD, MHS, CPH, dean of the USF Health COPH, if they could integrate structural racism into the academic master plan. Just like MCOM’s Dr. Bognar was previously quoted as saying that these changes have to be “baked in” the curriculum, Dr. Penniecook wanted these efforts to combat structural racism to be more strategic and woven into everything they do and who they are, so that it’s more likely to stick. A variety of work groups will be formed to include faculty, staff and students to look at admissions, curriculum, teaching methods, educational spaces and recruitment, and then make recommendations to the college structure. While this master plan is a work in progress and was paused when COVID-19 first hit, Dr. Petersen has already impacted and set the tone for the two freshman courses she teaches as a part of the Master of Public Health program. She has always had a required summer reading list, but this past summer, the entire list was equipped with books on structural racism. In addition, different aspects of structural racism have been the topic of several of the College’s townhall meetings, some lead by students, as well as episodes of the Activist Lab’s Activist Lab on the Road podcast.

An interprofessional student team across the Colleges of Medicine, Nursing and Public Health, and the School of Physical Therapy, at the 2018 USF Health Research Day. Pre-Covid Photo.

The curriculum used to educate our future health care professionals is only one piece of the puzzle. The faculty who teach it are the other. “Student exposure to those from impoverished backgrounds may occur for the first time when they are in medical school,” Haywood Brown, MD, professor of obstetrics and gynecology, associate dean of diversity for USF MCOM, and vice president for institutional equity for the University of South Florida System, said. “They don’t get that in the classroom because there is so few, diverse faculty teaching the curriculum.” According to a board diversity statement from the American Council on Education (ACE), diversity in university student bodies, faculties and staff, enriches the educational experience, promotes personal growth and a health society, strengthens communities and the workplace, and enhances America’s economic competitiveness. “If you do not have a diverse workforce, the patients don’t benefit as much because you’re learning from each other,” Dr. Brown said.

In November 2020, the USF Health College of Nursing appointed Usha Menon, PhD, RN, FAAN, as the new dean after serving as interim dean of the College since February of that year. According to Dr. Roman, under this new leadership, one of the College’s initiatives is to increase the diversity, equity and inclusion not only in the curriculum, but also in the student, faculty and staff populations. As a part of this initiative, Dr. Menon realigned her senior administrators which included creating a director of diversity role, now filled by Ivonne Hernandez, PhD, RN, IBCLC, assistant professor at the USF CON. “What we are developing now, before we even start recruiting, is a way to retain,” Dr. Roman said. “We are nurse scientists, and we treat our patients and our students by the evidence. We are doing the same thing with diversity, equity and inclusion, and what our data shows is that when we have persons of color, they don’t stay.” CON’s strategic goals include increasing the diversity of research faculty by 35% and of clinical faculty by 10%, by 2023. One retention method coming soon is a mentoring program.

According to Dr. Roman, CON is not making these changes just to check off a box for diversity on a list of requirements. “The College of Nursing is doing a 360,” Dr. Roman said. “We’re changing everything. We are doing the right thing for all people and it’ll be a complete culture change.” A healthy and safe culture and work environment will also help retain high quality, diverse faculty. “We have to reiterate that incivility is not tolerated, and micro and macro aggressions are not tolerated,” Dr. Roman said. “We also have to bring to the forefront what already exists in the University processes for what to do if you feel violated and not to suffer in silence.”

Even outside of the university classrooms, USF Health students are coming together to fight racial disparities in the healthcare system. In August 2020, MCOM became an official chapter of the national White Coats 4 Black Lives. Open to all USF Health students, the goal of the organization is to safeguard the lives and well-being of patients through the elimination of racism. To accomplish this goal, WC4BL and the USF Health chapter look to foster dialogue on racism as a public health concern, end racial discrimination in medical care, and prepare future physicians to be advocates for racial justice. “It’s everyone’s responsibility, but it’s only a priority to some,” Smith said. “For those who make it their priority, we want to give them tools to learn how to engage in these spaces that make it safe for them and make it safe for the other person to have these kinds of courageous conversations. Equipping the next generation of thought leaders so they can change the thoughts out there.”

The Healthcare Imaginarium for Exponential Technologies, or HIETs is the brainchild of visionary College of Pharmacy Dean Kevin Sneed

Kevin Sneed, PharmD, (standing right) dean of the USF College of Pharmacy, spoke about how exciting new technologies would be integrated into the college’s currriculum starting this fall.

TAMPA, Fla. (Feb. 22, 2018) — USF Health’s Pharmacy Dean Kevin Sneed, PharmD, announced this week several key initiatives intended to integrate advanced technologies into the student curriculum and to keep the college at the cutting-edge of innovation in education, research and patient care. He spoke Feb. 20 to a gathering of business and community leaders, as well as students, faculty and staff.

“We want our USF College of Pharmacy to remain relevant not only today, but for the next 25 years,” Dr. Sneed said.  “Right from the beginning, our mission has been to revolutionize health through innovation and empowerment… Now is the time to reimagine what education will be moving into the future.”

The initiatives are part of a newly created Healthcare Imaginarium for Exponential Technologies or HIETs.   They include the introduction in fall 2018 of virtual reality content to supplement existing curriculum and help make the learning experiences of USF pharmacy students more immersive and life-like than textbooks, online content and traditional videos.

Many of those gathered used mobile device technology to record the event.

Students will put on special eyewear to view computer-generated images they could interact with. So for instance, they might experience in 360-degree, three-dimensional context the growth of plaques in coronary arteries and what happens when a stent is inserted to clear a clogged artery.  In yet-to-be-developed ways, virtual reality technology may also seamlessly combine pharmacology with physiology to simulate the effects of treatment. For example, students could visualize in real-time the action on smooth muscle airways when a bronchodilator drug is inhaled by an asthma patient. Such advanced technology could also be harnessed by health professionals as a more engaging way to educate patients about their diagnoses and care, Dr. Sneed said.

The College of Pharmacy plans to work with MediaLab 3D Solutions, a Tampa-based digital content creator, and BioLucid, a digital health company recently acquired by Sharecare, to develop a combination of virtual, augmented and mixed reality content.

USF pharmacy student Natalie Dehaney demonstrates how virtual reality technology allows students to visualize what happens inside the body when a patient experiences atrial fibrillation. She can trigger and replay the simulation of electrical conduction in the heart. 

MediaLab CEO Bruce VanWingerden said the project will be the first time the company, which works with major corporations, has ventured into academia. “This is an exciting opportunity to work with Dr. Sneed and his staff to really look at different ways to present in a new and exciting fashion information that can be difficult to convey,” VanWingerden said. “We want to take all the innovative technology and make it easy to use to further the educational process.”

Laysa Mena, a student delegate for the College of Pharmacy, describes herself as a “visual learner” who absorbs more by seeing than reading. “So I feel implementing virtual reality with our curriculum would be very beneficial and give us a better appreciation of how drugs work in the body,” she said.

Dr. Sneed announced a key initiative known as the Botanical Medicinal Research Consortium, which will team USF researchers and clinicians with local companies to conduct evidence-based  clinical research on whether non-euphoric forms of cannabis may benefit patients with certain diseases.

Another key initiative, known as the Botanical Medicinal Research Consortium, or BMRC, will bring together researchers and clinicians in USF’s colleges of pharmacy and medicine, the university’s Center for Drug Discovery & Innovation, and businesses in Tampa Bay and beyond to conduct rigorous studies on the safety and effectiveness of medical cannabis and other plant derivatives.

Many unanswered questions remain about the potential of cannabinoids, the active chemical found in the plant and elsewhere, to treat various diseases or conditions like chronic pain. The USF College of Pharmacy wants to take the lead in conducting top-quality research on medical cannabis and find the correct noneuphoric formulations that may benefit patients and their overall health, Dr. Sneed said.

Mark Kindy, PhD (left), professor of pharmaceutical sciences, is the College of Pharmacy’s liaison for the Botanical Medicinal Research Consortium, and Kevin Olson, PharmD, MBA, assistant professor of biopharmaceutics and clinical research, is the liaison for the Entreprenerial Academy, a collaboration with the Muma College of Business. 

“Plant-derived compounds are the future of medicine, and we’re looking forward to collaborating with the University of South Florida in this area,” said Garyn Angel, chief strategy officer for ANANDA Scientific, a company that produces nonpsychoactive and nonabusive oral cannabinoid health products. “Evidence-based clinical research is needed for cannabinoids to enter Western medicine.”

Dr. Sneed also announced that the BMRC would collaborate with the UCLA Cannabis Research Initiative at the UCLA Semel Institute for Neuroscience and Human Behavior, one of the first academic programs dedicated to investigating cannabis to lead public policy and public health decisions.

Other HIETs initiatives include:

• With the College of Engineering, USF Pharmacy will work to advance personalized medicine that tailors therapy based on an individual’s genetic makeup. As the technology of medicine and drug development continues to shrink down to the nanoscale, USF has also started a Pharmaceutical Nanotechnology master’s program to teach students how to deliver medications in new, more precise ways.

• The College of Pharmacy will join forces with the Muma College of Business to create an Entrepreneurial Academy that inspires innovation and start-up companies.  The aim is to help pharmacists think like entrepreneurs so they can better enhance heath care outcomes and cost-effectiveness.

• Clinical trials: Through its WE-CARE program (Workgroup Enhancing Community Advocacy and Research Engagement), the College of Pharmacy partners with key stakeholders to increase participation of minority and medically underserved populations in clinical trials.  The program seeks to ensure that all communities have access to genomic clinical research as technology advances.

-Photos by Torie Doll, USF Health Communications and Marketing

With her grades and work experience, Morgen Schmitt could have had her pick of pharmacy schools, but she doesn’t hesitate when asked about her decision to enter the Tampa-based USF Health College of Pharmacy’s first class in 2011.

“I looked at a lot of programs, and, hands down, USF’s had the best curriculum,” says Schmitt, now in her second year of the four-year USF Doctor of Pharmacy degree program. 

Schmitt has no doubt that she will be ready to take on a leadership role as a clinical pharmacist when she graduates. “I want to be a vital part of shaping the healthcare transformations that will improve patient care and quality of life and reduce medication errors.”

Kevin Sneed, PharmD, far right, founding dean of the USF College of Pharmacy, stands with students at the 2012 White Coat Ceremony.

That passion among students to embrace the challenges of a changing health system does not surprise Kevin Sneed, PharmD, the college’s founding dean.  Built around the idea that pharmacists will be the hub of the future healthcare team, the innovative, rigorous curriculum emphasizes a collaborative approach to patient care and research among pharmacy, medicine, nursing, public health and other health professions.

The college continues to advance on a fast track forward.  Recent program successes and highlights include:

–  This past summer, the program was awarded accreditation status by the Accreditation Council for Pharmacy Education.

–  Increasingly competitive as it grows toward a projected complement of 400 students, the college attracted nearly 800 applicants for 100 spots in the 2013 entering class.

– This year, USF pharmacy students begin working alongside medical students and treatment teams in the USF Health Center for Advanced Medical Learning and Simulation, where they will demonstrate competency preparing medication orders safely in a life-like virtual environment before advancing to real retail and inpatient pharmacies.

– With a comprehensive array of clinical internship sites in metropolitan and rural areas, USF offers more training resources than virtually any other pharmacy program in the Southeast.

– USF’s alliance with CoreRX, a research-based drug development firm, is just one example of the college’s commitment to entrepreneurial academic partnerships offering students hands-on experience managing and delivering technologically-advanced pharmaceutical care.

Aging Baby Boomers with more chronic conditions. The emergence of pharmacogenetics and its implications for care based on an individual’s genetic profile. The need to master health informatics to reduce errors and duplicative services.  All are converging to create the need for a new breed of healthcare practitioner who can lead, innovate and work effectively in teams.

USF is at the forefront of preparing those pharmacists today, Dr. Sneed says. 

“If we are truly concerned about improving the health of patients while keeping costs down, then more fully integrating pharmacists into medication therapy decisions is critical — to make sure we get the right patient the right drug, at the right time.”

Photo by Eric Younghans, USF Health Communications

This story appeared in the Spring 2013 issue of USF Magazine.