Designing and Implementing a Novel Virtual Rounds Curriculum for Medical Students' Internal Medicine Clerkship During the COVID-19 Pandemic

Abstract

Introduction During the COVID-19 pandemic, third-year medical students were temporarily unable to participate in onsite clinical activities. We identified the curricular components of an internal medicine (IM) clerkship that would be compromised if students learned solely from online didactics, case studies, and simulations (i.e., prerounding, oral presentations, diagnostic reasoning, and medical management discussions). Using these guiding principles, we created a virtual rounds (VR) curriculum to provide IM clerkship students with clinical exposure during a virtual learning period. Methods Held three times a week for 2 weeks, VR consisted of three curricular components. First, clerkship students prerounded on an assigned hospitalized patient by remotely accessing the electronic health record and calling into hospital rounds. Second, each student prepared an oral presentation on their assigned patient. Third, using videoconferencing, students delivered these oral presentations to telemedicine VR small groups consisting of three to four students and three tele-instructors. Tele-instructors then provided feedback on oral presentations and taught clinical concepts. We assessed the effectiveness of VR by anonymously surveying students and tele-instructors. Results Twenty-nine students and 34 volunteer tele-instructors participated in VR over four blocks. A majority of students felt VR improved their prerounding abilities (86%), oral presentation abilities (93%), and clinical reasoning skills (62%). All students found small group to be useful. Discussion VR allowed students to practice rounding skills in a supportive team-based setting. The lessons learned from its implementation could facilitate education during future pandemics and could also supplement in-person clerkship education.

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

“…Medical students were engaged securely via mobile phone to participate in the ward round, including discussion before and after a patient visit. Sukumar et al shared internal medicine clerkship experiences at a university hospital [ 33 ] in three steps; students pre-rounded an assigned hospitalised patient by remotely accessing their electronic health records, then calling into hospital rounds virtually, followed by oral presentation to their small group of instructors and fellow students. Kopp et al [ 34 ] provided third-year medical students an opportunity to join inpatient medicine e-Consult teams which includedCOVID-19 patients.…”

“…Iancu et al [ 13 ] highlighted telemedicine education as an important aspect of future medical student training, especially in augmenting traditional in-person clinical experiences. Telemedicine engaged students and patients in diverse clinical settings providing a platform to teach wide range of clinical skills including clinical reasoning, professionalism, and communication skills during a pandemic [ 14 , 19 ] with high satisfaction levels [ 14 , 33 ]. The publications reporting clinical teaching via telemedicine during the COVID-19 could serve as a scalable model for future educational programs to be incorporated into the medical student curricula [ 21 ] and expanded into outreach programs, especially in underserved rural communities [ 19 ].…”

Application of digital education in undergraduate nursing and medical interns during the COVID-19 pandemic: A systematic review

“…The 16 papers used a variety of methodologies, including one cross-sectional study, two quantitative descriptive studies, two quasi-experimental studies, one prospective cohort study and the rest of the ten mixed-method studies. The publications were devoted to exploring the different modalities of digital education, including virtual reality-based simulation training (3 studies) ( De Ponti et al, 2020 ; Kang et al, 2020 ; Weston and Zauche, 2020 ), teleconsultation and virtual rounds (3 studies) ( Bala et al, 2021 ; Sukumar et al, 2021 ; Weber et al, 2021 ), web-based specialized skills learning (2 studies) ( Alpert et al, 2020 ; Shahrjerdi et al, 2020 ), and multimodal online curriculums (8 studies) ( Coffey et al, 2020 ; He et al, 2021 ; Kaliyadan et al, 2020 ; Kasai et al, 2021 ; Michener et al, 2020 ; Samueli et al, 2020 ; Williams et al, 2021 ; Zhou et al, 2020 ). Study outcomes were measured utilizing a series of homemade tools.…”

The Virtual Team Member: Remote Engagement of Medical Students in COVID-19 Care

“…Although didactic sessions on communication skills were given in our elective, formal orientation modules on telemedicine delivery such as nonverbal behavior, i.e., telehealth best practices, could have increased student confidence and satisfaction with this type of patient interaction [ 12 , 20 – 22 ]. We could have further bolstered the elective by including a dedicated small group virtual round for medical students with volunteer tele-instructors similar to what has been utilized in internal medicine clerkship rotation at another institution [ 16 ]. Feedback from the hospitalists was difficult to obtain systematically, due to overwhelming clinical responsibilities.…”

“…Unlike pre-clerkship courses where transition to online learning formats has been less disruptive while meeting educational outcomes, preserving the value of clinical experiences would be difficult while physically distanced from patients and the care team. Throughout the pandemic, educators have collaborated with clinical faculty to create virtual educational activities in lieu of paused clinical clerkships such as medicine, surgery, and ophthalmology using combinations from self-study material to online didactic/case discussions and telehealth experiences with variable effect since the objective measures ranged from student specialty interest to knowledge [ 11 – 16 ]. Unpredictable changes in onsite team activities due to the uncertainties of COVID-19 care could lead to inconsistent student experiences in team engagement, supervision, and inclusion in the clinical decision-making process.…”