I really enjoyed this week’s lecture because I got to meet the people helping to make decisions at Emory during COVID. I thought they did a really good job with their recommendations, and I personally had a great experience going to Emory during COVID, despite the unprecedented situation we were in. Although not all recommendations were adopted at the law school, such as 60-minute exams and not having proctored exams, a lot of the recommendations were adopted. Really helpful recommendations for zoom school were having each class recorded and making in person class optional if a person needed to stay home.

The student survey that Dr. Weeks spoke about also really stood out to me. People were worried that being schooled via Zoom at home would not be ideal. They were worried about having a quiet, internet-connected place to go to class and study. They were also worried that making friends and finding study groups would be much harder.

These worries were extremely relatable to me. I remember going through this situation myself, and ultimately choosing to go to law school even though the classes would mostly be on Zoom. My experience was different from my undergrad experience, and I struggled with many of these issues. I was fortunate to have a lot of other students living in my building, and so I was able to find one or two other students to study with. Overall, I am grateful we had professionals such as the ones that came in to make these decisions.

It was extremely fascinating to hear from people who had influencing voices during the rapid shift to virtual learning and could provide insight into what the thought process behind certain choices was. I found it equally interesting that the individuals leading the Impact on Education seminar chose to focus only on the limitations of the virtual learning format. Although it is well known that the pandemic brought about several issues (such as isolation, depression, increased domestic abuse, etc.), one thing that came about—that I view as a positive—is the ability to work virtually and the positive consequences of this tool.

Despite the very notable issues associated with virtual learning, several benefits are also associated. For example, although mental health issues did arise as a result of virtual learning, for those that experience severe social anxiety, mental health issues may have been eased. For those that have complex and quickly moving class material, students were able to pause, slow down, and rewatch course lectures and therefore, have a more solid understanding of the material. When fatigue and hunger would set in during the middle of a lecture, students could pause the material, take a break and resume rejuvenated and focused. For students that have invisible disabilities (i.e., although they may appear perfectly able bodied, they face challenges) and may be unable to attend classes, they have easy access to lectures without having to provide medical information to the school/professors. While there are several challenges linked to online learning, these examples illustrate that there are also several positive outcomes of virtual learning which brings me to my next point. During the Impact on Education seminar, I was utterly shocked when one of the speakers mentioned that he was debating if he should or should not record and post lecture videos next semester. I was completely stunned at this statement because, a person in his position should be aware of not just the negatives related to virtual and hybrid learning, but also the associated benefits. Additionally, I was shocked at his statement because it minimizes the experience and needs of people with invisible disabilities, social anxiety, or students who get sick and prefer not to potentially infect their fellow classmates. In short, the virtual or hybrid format is a tool (not without limitations like other tools and approaches) that has been proven to be effective at enhancing productivity—below is an article that further details this. Ultimately, I hope that individuals in a position to influence change on campus will continue to speak to students about their experience, resources needed, etc. (this should not be the first and only time a forum type of discussion with students related to the impact of COVID occurs) and advocate for solutions that considers everyone and their unique needs. Additionally, I hope that professors and others realize the potential benefits of the virtual and/or hybrid format and use it in combination with live classes (e.g., simply record and post lectures for their students) because I firmly believe this small action can make a major difference for countless students.

Article link: https://www.shrm.org/hr-today/news/hr-news/pages/study-productivity-shift-remote-work-covid-coronavirus.aspx

Dear Students,

I was walking across the Quad a few days ago, and I happened to overhear a fragment of a conversation between two Emory students. “I just feel so anxious right now,” one student said. Those words stayed with me.

…But you have something my generation didn’t–the strength to speak eloquently and openly about mental health…that is a gift, and I’m proud about how you support each other.

-PResident fenves, october 10, 2021

Last year, I remember receiving an email from President Fenves on World Mental Health Day. He recounted a story of overhearing two Emory Students speak on how anxious they were. He said those words stayed with him. Moreover, he spoke about how eloquently and openly we are able to speak on mental health. While he had good intentions, and it is true that as a society we are more open about mental health, there’s only so much that speaking can do. Students want change. 

Although there was a significant increase in mental health concerns during the pandemic, this is just a continuation of a trend, which researchers and clinicians have been pointing out for years. In fact, it’s getting worse with American Indian/Alaskan Native students taking the brunt of the increases in mental health problems. 

A huge part of this stems from the disconnect between university administration, faculty, and students. Researchers Wendy Fischman and Howard Gardner from Harvard University assessed over 2,000 interviews with students, parents, faculty, administration, and alumni over a five year period and across ten campuses. They discuss in their book that faculty members and university administrators believed students’ main mental health issues were due to an increased workload compared to high school or being in a new environment away from home. Yet, students were actually concerned with the pressure to succeed and get a perfect 4.0 GPA. In HLTH 100, a class I teach as a Peer Health Partner, we are told to harp on strategies to combat the transition into a new space; however, when I speak to the first-year students, they echo Fischman and Gardner’s research.

Thus, as Dr. Glass stated, there is a systemic issue of students quantifying their worth because of a college environment and society based so heavily on doing well. Emory, especially, tends to glorify the concept of being busy, and students feel the need to fill up every moment of free time. Personally, I see this amongst students with post-graduate plans and/or are in pre-professional programs where there is a prominent narrative that there are only a few spots that will be given to the top students. Consequently, grades no longer become feedback, as faculty hope them to be, but rather are currency that have the potential to make or break a potential career path. 

The disconnect continues within the classroom and varies faculty member to faculty member. Some professors have assigned me exams that open and close on the weekend, while others have graciously granted me extensions due to health concerns. I have had lecture quizzes open right after lecture and due at 7pm the same day, ignoring the fact many students work late at their jobs, or extracurriculars, making this an impossible deadline. Though, I’ve also had professors kindly post all assignments, materials, and quizzes a week in advance, enabling me to be able to work ahead of time and accommodate for my job. 

Given these variations, there needs to be consistency between professors and a more transparent process with regards to student feedback. Administrators also should be keen to hear student advice and faculty experiences. Moreover, there is a dire need for more mental health resources on campus. Dr. Weeks spoke about the amazing advice he gave professors, and the immense work that went into making sure student learning was worth our tuition during the pandemic year(s), but not all professors applied and continue to apply these recommendations. Furthermore, I was delighted that Dr. Rickard spoke about CAPS, and its work to aid students, especially during isolating pandemic semesters. However, CAPS is not meant to be a long-term solution, only provides eight sessions focusing mainly on students’ academic stress, and has a bad rap amongst students due to its long wait times. 

Ask any student about the atmosphere on campus, and they will tell you that mental health is not being adequately addressed on campus. And, it seems that any steps that have been taken are inhibited by the underlying disconnect.

So, what do you all think should be done to address these mental health issues and disparities spoken about in class? And, what can be done to address the disconnect?

While not unique but rather exasperated by covid, academic burn out specifically in professional students continues to come to new peaks. In my personal experience this comes from academic institutions and students having often unaligned interests when it comes to early career placements. Specifically in the emory law school career services is designed to place the top students with the most prestigious and high paying jobs that they are able to form recruitment partnerships with. Students in lower rankings within their class have their preferences overshadowed by university preference to take the highest paying job possible given their credentials. These jobs that students are steered towards are likely not within their desired specializations which leads to a harmful message that either be top of the class or you’re not good enough. Whatever options are available to lower ranked students are often very niche and also competitive due to the largest student base being qualified for them. Whats left is a hole in how students are able to pursue their interests without being top of the class.

As mentioned in this weeks class a lot of this stems from systematic pressures driven by capitalism. Capitalism inherently drives us to constantly be competing, with historically employers having the highest bargaining power. Employers bargaining power transfers to institutions and then is passed on to create an immensely competitive culture with students leading to high stress levels and strained mental health. Prior to pursuing my law degree I worked in an accounting firm that exemplified this capitalistic culture to a tee. Within that company skipping lunch breaks and committing to long periods of overtime were rewarded with accolades while work flexibility, balance, and pay transparency were discouraged. As a result of the culture there, as well as the one we experience academically, we are constantly pushed to work more, to do the most, and in turn be conditioned to provide the most value to employers. So when firms are partnering with academic institutions to give their top students high salary positions they are essentially following predictable economic motives to get the most bang for their buck. And in the time when current partners were in our position this method didn’t pose problematic due to general lower cost of living and a larger thriving middle class.

What the issue is now is that is compounding that pressure is a high spike in cost of living due to covid driven inflation. During the period of reduced production, supply in many sectors was depleted while we are now experiencing once again high demand. Companies are taking advantage of demand by hiking up prices so that they still experience annual revenue growth and by making investments that are pushing the American dream further and further from reality (real estate investors capitalizing on financial hardship through foreclosure buys). To translate a lower and lower percentage of the population is hoarding more and more of the wealth. This creates the academic stress that we discussed of not necessarily finding the “best” job but rather finding a job that can sustain our expenses and then factoring in how that job aligns with our goals and happiness. So career services is behaving very predictably given current social and economic conditions. Another issue increasing in prevalence as a result is when students accrue debt in the pursuit of their passion, realize their passion is not feasible given their current debt load and projected expenses, and are locked into a profession concentration they are unhappy with. Given these conditions it is unsurprising the exponential increase in academic distress that Gary Glass highlighted.

While the great resignation did allow for some increase in bargaining power, the playing field is unlikely to be anywhere near level without some real systematic change. One path to igniting this change is returning to actually previously present “maximum” wages regulated by progressive tax rates, free undergraduate education tuition, and corporate taxes that discourage wealth hoarding. Prior to the Reagan administration the largest marginal tax rate was 70% that he reduced to 50% through The Economic Recovery Act of 1981 and now is almost half of what it was at the start of his administration at 37%. While colleges have a history of fees, the word tuition used to be a relatively innovative concept with the University of Florida first charging in state students any tuition in 1969 and California not having any tuition until once again Reagan took office, but back when he was governor. If my political alignments were not already clear, I have some strong disagreements with our prior administration however I believe the phrase “Make American Great Again” does have some use and just needs to some revaluation of what America has done that was “great”.

Capitalistic culture is not swayed just by discussion around what is instead required is an extreme restructuring of incentives. Being that my perspective is limited to the fields of accountancy and law, I’m interested how these incentives present themselves in the medical and public health fields so please engage with comments.

 

https://time.com/4276222/free-college/: Education Burnout and its Capitalistic Origins

Last week, we had the privilege of hearing from Dr. Emily Bianchi from Goizueta Business School. Given her expertise in recessions, she discussed psychological strategies often used to manage uncertainty. She noted that humans despise uncertainty, so much to the point that humans would prefer to definitely get shocked and know the frequency of those shocks that will be administered as opposed to having a 50/50 chance of receiving or not receiving shocks. She suggested that the hatred of uncertainty may stem from the anxiety and fear neurologically arising from uncertainty, and we thus have many compensatory strategies to overcome uncertainty.

One such compensatory strategy is relying on conspiracy theories to explain challenging concepts. During Dr. Bianchi’s discussion, I was immediately reminded of the numerous conspiracy theories about COVID-19. The Alliance for Science at Cornell University eloquently outlines the top 10 conspiracy theories about COVID-19 as of April 20, 2020—during the early stages of the pandemic in the United States (Lynas, 2020). Several conspiracies, from those involving Bill Gates to big pharma, were not rooted in logic. One widespread conspiracy theory I heard was that COVID-19 was created by Chinese scientists to be used as a biological weapon; in fact, 23% of Americans thought that COVID-19 was intentionally made (Schaeffer, 2020). Some (ideologically) conservatives, like Senator Tom Scott, pushed this theory that the Wuhan Institute of Virology was involved in biological warfare (Stevenson, 2020). Nonetheless, there is now genetic sequencing evidence that the coronavirus in question has origins in bats (Lynas, 2020).

Considering that conspiracies tend to come from uncertainty, do you think that there would have been fewer about COVID-19 if the Trump administration shared some notions with certainty about COVID-19 (ex: what the government will do to mitigate the spread of the virus instead of not addressing it)?

Burnout in health care is often characterized as a state of emotional exhaustion with degrees of depersonalization, detachment from patients, and apathy regarding work. The U.S. Surgeon General released an advisory on health worker burnout earlier this year. While this is not a new phenomenon, the rates of burnout have massively increased since the start of the pandemic. This is particularly significant because, according to a 2019 report from the U.S. Census Bureau, healthcare workers make up 14% of the U.S. labor force, making it one of the largest sectors. Before the pandemic, the healthcare industry already had a supply and demand problem. This has only worsened over the last few years. While burnout cannot be solely attributed to this problem, it is a significant factor. Hospitals and organizations are trying to implement supportive programs or initiatives to mitigate the levels of burnout. To an extent, usually on an individual level, some of these are very helpful. But overall, there does not appear to be a plateau anywhere in site.

We know from Dr. Dittmann and Dr. Bianchi’s presentations the covid-19 pandemic was not “the great equalizer” early reports hoped it might be in 2020. In fact, I would argue the pandemic shined a brighter light on the inherent inequalities and lack of social services in the U.S. For healthcare workers, this became something we could no longer compartmentalize away. My first covid patient who died most likely contracted the virus while working overtime in an Amazon warehouse because his family could not afford for him to stay home. I cared for more children in the ICU who attempted suicide in 2021 than I did for my previous five years combined. We had to wear our N95 masks for eight 12-hour shifts before getting new ones, knowing they were no longer effective by the end of the first shift. These experiences were too numerous and impactful to accept as the status quo. Practically three years in, there are still very few resolutions, and I believe that is one of the main drivers in healthcare worker burnout. We can’t alter the past, but we can’t ignore it either. I don’t know what the answer is to addressing burnout or other issues in the healthcare workforce. Maybe reflecting back as we do for this class will provide some insight. Regardless, change is inevitable, and I hope we remember and reflect on these impactful patients and co-workers and all of the unfortunate things covid-19 highlighted.

A main point that stuck out to me from Tuesday’s lecture was the identification of uncertainty as a driving force for shaping behavior during periods of recession. This makes a lot of sense to me, as the desire to understand the world feels intrinsic in our humanity. Lacking the ability to do so would clearly cause mass fear and anxiety, and in turn, the gravitation towards explanations that can rectify this discomfort. In my psychology course last year, we heard a lecture on conspiracy theories that broke down the reasons why people follow them so fervently. The first reason, as Dr. Bianchi mentioned, is epistemic. We are motivated to understand our world and have wired-in needs for predictability and closure. From a sociological perspective, predictability is a huge motivation as to why people ascribe to social structures and constructs; these unwritten rules lay a groundwork for expected interactions between individuals and groups. During a worldwide pandemic, when the typical norms of social and economic life are thrown out the window, it makes sense why people look to conspiracy theories to mitigate the abundance of uncertainty. Another aspect that contributes to this is existential. Humans have the need to feel safe and secure in their environment, and feel like they can exert control over the environment as autonomous individuals. Identifying a cause of otherwise unexplainable societal disorder offers a sense of agency, as it provides a clear line of reasoning that can be intervened with. The last motivation for ascribing to conspiracy theories is social, or the desire to belong. Those who are socially detached are more likely to believe in conspiracy theories, and doing so provides community and purpose within a social society. Dr. Bianchi noted that uncertainty creates a psychological need to associate with others. It provides comfort, sense-making, and a model for normative behavior. During COVID especially, when health promotion required the separation of people, the intrinsic need for community felt even greater. 

Conspiracy theories are dangerous and impactful, yet they can be used to reflect epistemological, existential, and social aspects of human nature. This is demonstrated in interviews with those deeply involved with conspiracy groups, as they often share sentiments of feeling control in the cause-and-effect nature of radical explanations. Understanding how they are rooted in uncertainty during periods of recession provide greater context within which these movements can be analyzed.

For this post, I’d like to talk about my experience as a front-line worker during the earliest parts of the COVID-19 pandemic. By March of 2020, I had been working as a flight attendant for just over 3 years. The career brought me a lot of joy and allowed me to have so much freedom. I genuinely enjoyed every aspect of the job. However, like a light turning out, that so quickly faded when the pandemic began. At first there was fear of infection, fear of keeping myself and my family safe. Then, as planes emptied and airports became ghost towns, a new fear of the greater global instability that lay ahead set in.

For a short period, there simply was no flying. My scheduled trips dwindled and when I did work, it was to fly passenger-less planes to hangars for maintenance. After a few months, people came back, but really only out of necessity. A few more months after that, flights resumed to at least 75% capacity. However, these passengers were unlike anything I had experienced before. They were angry, tired, stubborn, impatient, and probably afraid. It suddenly felt like every flight was a point of contention, a fight to have them mask, or simply just obey basic air safety instructions. The job became exhausting and anxiety-provoking.

I talk about my experience to give a little insight for those that maybe had the ability or luxury to stay at home. While I was so grateful to still have a job, it can still be okay to acknowledge how difficult that time was. As a result, so many in the aviation industry simply quit or retired early. There was a collective fatigue that formed not just within my field, but everywhere. In a good way, people began to realize there were other options for work. People also went back to school (me!), or began new trades, or found ways to work from home. The shift we saw, with individuals demanding more from their careers, was incredibly inspiring and still continues to be.

While covid-19 has transitioned employers to more permanently instating hybrid working models first introduced as pandemic measures, could this lead to further reforms to address employee burn out in the US? First it’s important to acknowledge how we came to the standard of the 40 hour work week in the first place. Originally passed in 1938 the Fair Labor Standards Act codified worker protections such as 44 (later amended to 40) hour work weeks and overtime compensation requirements. While at the time it was a huge success for industrial workers in a time of great wealth disparities between the upper and lower classes, why has it not been further modified to account for societal change and current disparities?

The above table provided by The Federal Reserve shows in green the top 1% share of wealth growing overtime since 1990, resulting in a smaller and smaller middle class. This growing inequality has been compared to levels during the US gilded age and the French Revolution but, due to less reliable data at those times it is difficult to confirm.

To translate how this relates to the growing demand for the four day work week, people are being overworked for less and less of market share and are realizing they are worth more. When the 1% profits off of underpaying and overworking employees to produce larger shares of wealth, the long told tale of the American dream is dying. With flexible work schedules as pandemic accommodations generally showing increased productivity and greater satisfaction, the transition “back to normal” is not happening without resistance. Along with the great resignation employees have played an uno reverse card on companies by taking back their bargaining power in numerous industries. Many roles such as teaching and nursing that cannot be performed from home are yearning for the flexibility that their peers have gained in their careers and with existing shortages, are in a position to not except otherwise. Below are some links that speculate on more of the benefits of the 4 day standard and I am excited to see where this goes.

https://www.mercer.com/our-thinking/career/four-day-workweek-the-cure-for-burnout.html https://fortune.com/2022/09/22/battle-for-talent-job-recruitment-4-day-week/ https://www.theguardian.com/commentisfree/2022/jul/29/could-long-covid-lead-to-the-rise-of-a-four-day-work-week

While the sudden transition to an online workplace initially caused fear and uncertainty, many employees found that they didn’t want to go back to their offices. This has caused a lot of questions regarding the most enticing ways for companies to retain their workforce while still managing to create a workplace culture.

However, there are some jobs that make it either more difficult or nearly impossible to work remotely. While we mostly discussed the example of nursing, physicians are also a part of the workforce that mostly require to be in-person. Some providers can work via telemedicine, such as psychiatrists, but certain physical manifestations of life such as blood tests or lung sounds can only be performed when in contact with another healthcare professional.

A similarly pressing issue is the issue of physician burnout. According to one study, at the end of 2021 and the beginning of 2022, 63% of physicians showed at least 1 sign of burnout. Part of the reason for this burnout is the inability of physicians to practice as they wish, which includes suboptimal working conditions such as having to rush from room to room or fighting with insurance companies.

Many in the medical field blame medicalization and the “business of medicine” for creating this work environment that directly clashes with what doctors had expected when they entered the field. But now that businesses are scrambling to redesign their workplaces, does this bring an opportunity to reshape how healthcare environments are structured to ensure that physicians, PAs, nurses, and others are less likely to suffer from burnout? Or will healthcare environments be told to “wait” until after COVID is “over,” and change never occurs because the momentum has been lost?