Rachael McGraw has big plans. And they’re not just for herself.
In December, she graduated from St. Catherine University in St. Paul with a master’s degree in nursing education. As McGraw talks about her studies, it becomes clear that this is about more than a career choice.
“We know that the care nurses give makes a difference, not only in how healthy patients are, but how healthy they feel,” McGraw says. Nursing, she notes, “is a science, but it’s also a caring art.” In addition to upper-level classes in disciplines that include physiology and pharmacology, her coursework also addressed questions such as: “What are the caring and the ethics and the passion that drive our work? And, of course, how do we teach that?”
McGraw herself has begun teaching in St. Kate’s master of science in nursing entry-level program, and hopes to earn a doctorate of nursing practice in the next few years. That means she’s taking her place in one of Minnesota’s largest and most crucial industries. According to state statistics, 430,700 people work for employers in the health care and social assistance sector, and four of Minnesota’s 10 largest employers deliver health care services.
That makes the quality of health care education just as crucial to the state’s future, and not just from an economic perspective. As Minnesota’s demographics change and its health needs evolve, state colleges and universities that offer such education are designing and redesigning their programs to address new challenges.
Teaching isn’t the only career path people with McGraw’s degree can follow. “Many high schools are using nurse educators in their professional track programming,” says Laura Fero, dean of nursing in St. Catherine’s Henrietta Schmoll School of Health. “Hospitals are big employers of nurse educators to provide continuing education for their employees.” They often are hired as care managers, and they educate patients on chronic disease. “Insurance companies are using nurse educators to telephonically manage patients and help them manage those cases at home,” she says.
Fero notes that nursing, like all health care professions, is evolving as community needs change. St. Kate’s is undergoing a strategic planning process regarding its nursing education, which includes bachelor, master, and doctoral programs. St. Kate’s is examining ways to deliver that education more effectively based on the needs of its students and its clinical partners.
“There is a large demand for mental health services, locally and nationally,” Fero notes. “We’re looking at mental health as a specialty for the nurse practitioner track.” What might that look like? “That could be somebody who could help patients access mental health services,” she says. “They are able to prescribe medications and manage the care of patients who are currently underrepresented or cannot access providers.”
In addition to nursing, the Henrietta Schmoll School of Health offers many other programs (associate to doctorate), including occupational therapy, physical therapy, social work, public health, respiratory care, sonography, radiography, health informatics, and holistic health.
“The fact that we have this very broad range of [health professional programs] and this large of a school of health provides opportunities for students to really interact with one another and really prepare in a high-quality way for interprofessional practice and collaboration with other health professionals,” says Lisa Dutton, the Schmoll School’s dean of health sciences. “We think that’s really a strength we have here.”
This interprofessional approach addresses the fact that health care involves more than just treating illness. “We’re looking at those determinants [of health], such as housing and access to care, food insecurity—how those impact health,” Dutton says. St. Kate’s seeks to “help students understand those determinants, and give them the tools to advocate on behalf of patients and their communities for the needs of overall health.” For instance, they can advocate in their organizations for policy changes.
Care for the whole person in the context of family and community, along with a focus on social justice, compelled the University of St. Thomas to integrate all of its health education programs into a new school. Last August, St. Thomas opened the Morrison Family College of Health, whose inaugural dean, MayKao Hang, has a distinctive resume. Hang brings to her new role a background in developing programs designed to address community needs, including leadership roles in affordable housing, health services, and systems change at the Wilder Foundation.
“The Morrison Family College of Health will be interdisciplinary, and will have a focus on having individuals from different fields gain knowledge to improve collaboration and cultural competency skills to improve health and wellness outcomes,” Hang says. She believes this is what makes St. Thomas’s new college distinctive. Its curriculum will not be looking at health solely as “the absence of disease, but an understanding of what keeps individuals, families, and communities well.” The college of health’s vision, she adds, “is to educate health providers and leaders who will skillfully, compassionately, and collaboratively advance the physical, mental, social, and spiritual well-being of individuals, families, and communities.”
In addition to St. Thomas’s degree programs in nursing and public health, the Morrison School’s curriculum will educate students in understanding and responding to diverse community needs—“learning how to deliver care in a way that meets the needs of the whole person and their life circumstances with technical and cultural competency,” Hang says. “What if the patient was homeless the night before? How are we going to handle that? We need to educate and have students consider the life circumstances that may affect healthy outcomes, and to be able to adapt and learn across a lifetime of working in service to others.” Language differences, family dynamics, and availability (or lack of availability) of social services are other considerations health care providers need to learn about, and address in their practices, she says.
“The skills that are needed for the 21st century need to be delivered in a culturally relevant way that can transform the experiences of the people needing the care,” she says. “If you look at just the seven-county metropolitan area, much of the growth is going to come from populations that don’t look like the current populations. That means more people of color, people from different ethnic groups, people who are culturally different.”
The social aspects of health care education have long been a part of the educational philosophy of the University of Minnesota Medical School’s Duluth campus, located on the grounds of the University of Minnesota Duluth. The Duluth campus was founded in 1972 with a focus on two primary missions: to train physicians for rural practice, and to help train Native American physicians, in part out of recognition of the health disparities Native Americans face. Duluth campus medical students spend two years in Duluth, then finish their MD at the medical school’s Twin Cities campus.
On the rural side, students are chosen for their willingness to consider a career in family medicine. “We believe that is a discipline that is particularly important for rural communities,” regional campus dean Paula Termuhlen says.
Nationwide, the University of Minnesota Medical School ranks number two for the number of American Indian and Alaska Native physicians that graduate from the program. It’s not the only metric that Termuhlen likes to cite:
Among the ways the Duluth campus prepares its students for careers in rural medicine is through what Termuhlen terms “immersive experience.” Future physicians spend five different weeks over the course of their two years in the Duluth medical program living and working with family medicine preceptors—physicians who serve as mentors and teachers—in a rural location. “We have health system partners and practice partners all over the state that will allow our students to come in—live, work, see, understand,” Termuhlen says. “We deeply appreciate how much these health systems help our students.” At the same time, she adds, these physicians and provider groups receive access to potential future employees.
Health professionals looking to climb the career ladder can access programs available at Saint Mary’s University, which has campuses in the Twin Cities, Winona, and Rochester. In addition to its on-campus programs, Saint Mary’s has created a number of online programs.
In 2018, Saint Mary’s launched an online master of public health (MPH) degree program. Many of the university’s MPH students seem to be coming from state, county, and local government, says Todd Reinhart, dean of Saint Mary’s School of Sciences and School of Health and Human Services. “We’re getting students who are practicing lab bench science,” conducting “the nuts and bolts of monitoring for critical public health aspects about what’s going on in communities. But they’re interested in doing something that’s more community-focused than laboratory work.”
The emphasis of the program is on foundational public health, such as epidemiology. The curriculum includes courses on the development and implementation of public health programs, such as for smoking cessation. (Saint Mary’s also offers online education that gives nurses with two-year RN degrees the opportunity to earn a bachelor’s degree.)
This past September, Saint Mary’s introduced a new “three-plus-two” physician assistant (PA) program, which it conducts in collaboration with Mayo Clinic School of Health Sciences. Students spend three years following a science and humanities curriculum on Saint Mary’s Winona campus. They then will shift to a master’s course of study in Rochester working with Mayo Clinic’s PA faculty.
Meanwhile, Saint Mary’s Graduate School of Health and Human Services is developing a doctor of nursing practice (DNP), which is transitioning from a master’s in nurse anesthesia program, as required by the accrediting body. (Historically, a master’s degree has been required to practice.) The DNP program provides an opportunity for nurses interested in working in the operating room.
In the Twin Cities metro, the University of Minnesota is the longtime leader in health education, with its medical, nursing, and public health schools all nationally known. But it’s not resting on its laurels. It, too, is making changes in how it educates health professionals.
Like other health education programs, the U of M is looking at ways to inculcate into its students practical insights into race, racism, and the social determinants of health. “This is a concept and an idea that has really gained momentum over the last decade or so, maybe longer,” says Anne Pereira, assistant dean of curriculum for the University of Minnesota Medical School. “But it’s one that’s really coming more into focus out in the community. We’re making sure our faculty has the development they need to understand it and to integrate it into the curriculum.”
The University of Minnesota is looking at ways to better address race, racism, and the social determinants of health.
She offers an example: “We’re working with our course directors who teach the second-year courses to really look at how to integrate what we know about race and racism into what students are learning in clinical practice courses.”
Incorporating a deeper sense of diversity and inclusion into physician education is one of the interrelated goals of a five-year undergraduate medical education strategic plan the U of M Medical School is now developing. Another goal, Pereira says, is to provide more experiential medical education. That’s in contrast to the traditional model, which she describes as “the transmission of information from faculty to students,” best symbolized by the big amphitheater classroom with the focus on the lecturer declaiming from the stage.
“We’re moving away fairly rapidly from the majority of our content being lecture-based to having more small-group, more interactive sessions that bring together students and a faculty facilitator,” Pereira says. That way, what these future physicians “learn can really stick, and they can really apply it to their practice.”
For example, she says, “We’re moving into more small-group learning, more simulation, more patient-based learning, learning from patients that come into the medical school and talk about their lived experience with illness.”
The changes in how the University of Minnesota is educating physicians, nurses, and other health professionals reflect the ways that health care education is changing.
That evolution is something Rachael McGraw learned as she studied for her master’s degree in nursing education at St. Catherine’s. One of her courses, on curriculum design, helped her to see how students start without any information and move through an entire set of concepts in a meaningful way, McGraw says.
“We think about education from what the learner needs,” she adds. “We also think about what kinds of curriculum we should design and what we want the future of health care to look like.” She’s among many who are reshaping programs to help health care professionals better serve patients within the context of their families, cultures, and communities.
Gene Rebeck is TCB’s northern Minnesota correspondent.