An outpatient telehealth elective for displaced clinical learners during the COVID-19 pandemic

Abstract

Background In response to the COVID-19 pandemic, medical schools suspended clinical rotations. This displacement of medical students from wards has limited experiential learning. Concurrently, outpatient practices are experiencing reduced volumes of in-person visits and are shifting towards virtual healthcare, a transition that comes with its own logistical challenges. This article describes a workflow that enabled medical students to engage in meaningful clinical education while helping an institution’s outpatient practices implement remote telemedicine visits. Methods A 4-week virtual elective was designed to allow clinical learners to participate in virtual telemedicine patient encounters. Students were prepared with EMR training and introduced to a novel workflow that supported healthcare providers in the outpatient setting. Patients were consented to telehealth services before encounters with medical students. All collected clinical information was documented in the EMR, after which students transitioned patients to a virtual Doxy.me video appointment. Surveys were used to evaluate clinical and educational outcomes of students’ participation. Elective evaluations and student reflections were also collected. Results Survey results showed students felt well-prepared to initiate patient encounters. They expressed comfort while engaging with patients virtually during telemedicine appointments. Students identified clinical educational value, citing opportunities to develop patient management plans consistent with in-person experiences. A significant healthcare burden was also alleviated by student involvement. Over 1000 total scheduled appointments were serviced by students who transitioned more than 80 % of patients into virtual attending provider waiting rooms. Conclusions After piloting this elective with fourth-year students, pre-clerkship students were also recruited to act in a role normally associated with clinical learners (e.g., elicit patient histories, conduct a review of systems, etc.). Furthermore, additional telemedicine electives are being designed so medical students can contribute to patient care without risk of exposure to COVID-19. These efforts will allow students to continue with their clinical education during the pandemic. Medical educators can adopt a similar workflow to suit evolving remote learning needs.

A scoping review on adaptations of clinical education for medical students during COVID-19

“…Adding to previous reviews, we found reports using telemedicine to overcome the challenges in clinical education amidst the pandemic disruption ( Table 2 ). 17 papers [ 8 , 9 , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ] described the use of telemedicine as an educational tool mostly for clerkship rotations but three also included pre-clinical year students. Whilst telemedicine was mainly implemented in university hospitals, six programs were also executed in the community.…”

“…5 ). Practice guidelines [ 11 , 12 , 20 , 22 ] and training for faculty and students were provided [ 10 , 14 , 16 , 18 , 20 , 22 , 24 ] prior to encountering patients over the telehealth platform. In-advance informed consent from the patients were obtained and screening took place to ensure patients had the appropriate virtual interfaces [ 18 , 19 , 21 ].…”

“…Illness script assignments reviewed by attending & different disease templates shared with students via online drive. 1,2,3,4,6,8,9 Univ FM US Weber et al [ 18 ] b 4-week virtual elective. Prior EMR training and introduction to workflow allowed students to document clinical information after encountering consented patients.…”

“…Rupley et al [ 11 ] implemented three obstetric projects where students provided: 1) public health and access information to vulnerable patients; 2) telehealth outreach to antepartum and post-partum patients scheduled for telehealth visits; and 3) post-partum outreach interdisciplinary efforts. Family medicine departments used telemedicine for communication skills education [ 16 ]; scripts and disease templates used in telemedicine were shared amongst students to widen their clinical knowledge [ 17 ]; and prior training in EMR (Electronic Medical Records) allowed students to contribute to telemedicine documentation of consented patients visits [ 18 ]. Ho et al [ 14 ] developed a pilot project integrating medical students into tele-ICU patient care using a 2-way video conferencing platform.…”

“…Students being excluded from the clinical space led to many novel ideas from clinical teachers who used the available technology to facilitate real patient contact in the ward or outpatient setting [ 29 , 38 , 58 , [60] , [61] , [62] , 65 ]. Even without real patients, the passion of clinical teachers has led them to become simulated patient themselves [ 36 , 37 ] and taught using clinical case scenarios allowing access to real patient imaging and EMR [ 18 , 19 ]. Albeit fewer in number, there were attempts at teaching clinical skills such as suturing, demonstrating that with advance preparations, basic technology and willingness, such education was possible over online platforms.…”