An Emergency Medicine Virtual Clerkship: Made for COVID, Here to Stay

Abstract

Introduction: Safety concerns surrounding the coronavirus 2019 pandemic led to the prohibition of student rotations outside their home institutions. This resulted in emergency medicine (EM)-bound students having less specialty experience and exposure to outside programs and practice environments, and fewer opportunities to gain additional Standardized Letters of Evaluation, a cornerstone of the EM residency application. We filled this void by implementing a virtual clerkship. Methods: We created a two-week virtual, fourth-year visiting clerkship focused on advanced medical knowledge topics, social determinants of health, professional development, and professional identity formation. Students completed asynchronous assignments and participated in small group-facilitated didactic sessions. We evaluated the virtual clerkship with pre- and post-medical knowledge tests and evaluative surveys. Results: We hosted 26 senior medical students over two administrations of the same two-week virtual clerkship. Students had a statistically significant improvement on the medical knowledge post-tests compared to pre-tests (71.7% [21.5/30] to 76.3% [22.9/30]). Students reported being exposed to social determinants of health concepts they had not previously been exposed to. Students appreciated the interactive nature of the sessions; networking with other students, residents, and faculty; introduction to novel content regarding social determinants of health; and exposure to future career opportunities. Screen time, technological issues, and mismatch between volume of content and time allotted were identified as potential challenges and areas for improvement. Conclusion: We demonstrate that a virtual EM visiting clerkship is feasible to implement, supports knowledge acquisition, and is perceived as valuable by participants. The benefits seen and challenges faced in the development and implementation of our clerkship can serve to inform future virtual clerkships, which we feel is a complement to traditional visiting clerkships even though in-person clerkships have been re-established.

A Review of Virtual Medical Student Rotations During the COVID-19 Pandemic: Their Role, Advantages, Disadvantages, and Future Prospects

“…Virtual rotations have been developed in almost every specialty, including but not limited to emergency medicine [ 4 , 5 ], geriatric psychiatry [ 6 ], intensive care [ 3 ], internal medicine [ 7 ], obstetrics and gynecology [ 8 ], ophthalmology [ 9 ], orthopedics [ 10 , 11 ], otolaryngology [ 12 , 13 ], pathology [ 14 , 15 ], pediatrics [ 16 ], physical medicine and rehabilitation [ 17 ], plastic surgery [ 18 ], radiation oncology [ 19 , 20 ], radiology [ 21 ], telehealth [ 22 ], urology [ 23 , 24 ], and vascular surgery [ 25 ].…”

“…There were many notable advantages and benefits of virtual rotations, for medical students including less cost, due to saving money that would have been spent on rent and travel, less time-consuming, with some rotations requiring as little as 2 hours per day commitment, more one-on-one time with attendings, as compared to in-person rotations which encouraged more one-on-one time with residents, students were able to obtain a sense of the culture of the program, more students were allowed to participate, than in previous years with in-person rotations only, the program’s schedule was more flexible, and hence this allowed students to also attend other required rotations. Other advantages included increased diversity and the increased ability of international medical graduates to attend [ 3 , 4 , 12 , 17 , 26 ].…”

“…Villa et al reported matching three of their interns from their virtual clerkship [ 4 ]. Yellin et al reported that 26.6% of candidates chosen to interview (17 out of 64) had taken part in their virtual rotation, and of those 17 candidates, eight were ranked within a “matchable range”, and of those applications, six were successfully matched into that residency program [ 10 ].…”

“…Medical students agreed that virtual rotations should be continued in the future based on the responses given in the studies by Villa et al (95% of 25 respondents) [ 4 ] and Mason and Aruma (22 out of 27 respondents) [ 11 ].…”

Application of Virtual Reality Technology in Clinical Practice, Teaching, and Research in Complementary and Alternative Medicine

“…This requires an unprecedented change in the way the medical education sector provides clinical instructions, in line with efforts aimed at prioritizing the safety and slowing the spread of the virus. Several studies have attempted to fill this gap by applying VR to medical education and training to support physician learning during social distancing [ 11 , 13 , 15 , 18 , 22 , 23 ].…”