Since I graduated with my bachelor’s in International Studies last Spring, I have been in somewhat of a state of limbo. I enrolled at UNC in the Global Health concentration of the MPH, but have struggled to find my true passion within the global health space. Compared to the impressive drive and expertise I see in my peers; I have felt comparatively directionless. I struggled this year, in part, I think, due to the online format of our courses, to feel like I have found my place in the global health space. However, despite reinforcing my passion for public health, I had not quite found my niche when it came time to begin the practicum search process.
It would be a lie to say I am disappointed to be completing my practicum online this summer. In fact, quite the opposite, I honestly feel that this experience could not have worked out more perfectly in my favor. My primary anxiety surrounding the practicum experience, for essentially as long as I can remember, has not been the practicum itself, but rather finding an opportunity that would not only be practically feasible, but which would align with my interests and career goals. I ideally wanted a policy-focused placement, working on women’s health issues, which would allow me to keep my RA position over the summer. I was so concerned during the search process, after facing rejection after rejection from viable opportunities, that I would end up with a loosely-global-related placement where, although I would still gain valuable experience and skills, I would not be doing work in which I was genuinely invested. So when we all received the email saying that due to COVID-19 travel restrictions, the global requirement of the practicum would be waved, I breathed a massive sigh of relief.
With this parameter eliminated, I was given the freedom to search for opportunities in North Carolina, tackling pressing health concerns locally. I feel fortunate to have been accepted at my current practicum position with the UNC Hospital’s Beacon Program. The program provides comprehensive, coordinated care to UNC Health System’s patients, families, and employees experiencing a variety of interpersonal abuse and includes services for children, victims of domestic abuse, or intimate partner violence (IPV), human trafficking, sexual assault, the elderly, and vulnerable populations. In my role as a policy intern with the Beacon Program, I am spearheading efforts to investigate, create policy recommendations, and bring awareness to patient safety and privacy concerns arising from a new federal statute, the 21st Century CURES Act, that requires health systems to make medical records more widely available to patients.
Implementation of the CURES Act has led to new safety concerns for patients whose family members or other caregivers may access their medical records via online portals and has reinforced existing patient safety and privacy vulnerabilities surrounding the MyChart and OpenNotes portals. For example, provider notes detailing child abuse or domestic violence may cause family members to retaliate and cause further harm to the patient. There are grave patient safety concerns for victims of sexual assault and stalking, whose records of abuse or location information may be more readily available to their abusers. In addition, standard-of-care issues exist for patients with stigmatized diagnosed conditions (mental health issues, STI status, etc.) recorded in MyChart. There should also be serious questions asked about the process of obtaining informed consent for these portals.
My work in the first few weeks of my practicum has been exciting and engrossing, as I have found that many of these issues have not been addressed or even discussed at all in academic circles, let alone translated into practical solutions in a clinical setting. I even spent the last week investigating how difficult it is to make a fraudulent MyChart account (read: attempted to do so) and found it to be shockingly easy. I am so excited to continue this practicum doing what I find meaningful and fulfilling work and begin working on policy avenues for protecting patients put at risk by this statute at UNC and elsewhere. I will also create materials for provider education on harm reduction and draft a commentary on the issue for submission to peer-reviewed journals.
I am happy to say that there has been more than a bit of serendipity in the way things have worked out during this practicum. Despite my previous worries, the opportunity to do a remote, non-globally-focused practicum has helped me discover my passion in the public health space and feel that I am contributing to work that will positively impact my own community. This format has also allowed me to continue to work as an RA part-time, and I have also had the added benefit of being able to work from my home office and spend a little extra time with my pandemic puppies (pictured above). This experience has so far taught me that sticking it out through anxiety and discomfort can often result in a surprising silver lining. I look forward to finishing the practicum to see what else I will learn from this opportunity.
Gabbi