Designing Virtual Medical Student Ambulatory Rotations in Light of the Coronavirus Pandemic: A Pilot Project

Abstract

Problem: Medical schools across the country have suspended in-person student clinical rotations in light of the ongoing COVID-19 pandemic to reduce transmission of infection, protect students, and preserve personal protective equipment (PPE) for health care workers on the front lines of care. The COVID-19 pandemic has led to a rapid expansion of outpatient virtual visits. While involving students into these visits will provide meaningful clinical experiences, and help offset the provider burden of increased virtual visits, students and preceptors alike may initially struggle initially in adapting to these new modalities due to the lack of a formal telemedicine curriculum.Approach/Method: The U.S. Department of Health & Human Services has relaxed HIPAA rules to allow for the use of audio and video communication technologies. This study aims to evaluate if ambulatory virtual visits can replicate key elements of the teaching model of in-person visits. Patient consent, preference for virtual visits (audio vs. video), and student involvement are documented in a virtual encounter note template created for this study. We evaluated several platforms to maximize patient access to visits including FaceTime, WhatsApp, Doximity, and Google Voice. Two virtual scenarios were evaluated: one in which students virtually interview patients alone first, and another in which students interview patients with their preceptors for the entire virtual visit. Outcome: Following our initial implementation of this virtual model, students and preceptors were able to replicate the general in-person clinic workflow with the exception physical exam maneuvers and procedures. Students saw patients virtually, completed notes, and participated in feedback sessions with preceptors for each visit. While this pilot study is ongoing, we wanted to share our workflow, note templates, and challenges in order to help other programs initiate implementation of their own student virtual visit encounters. Next Steps: The unique ability for students and preceptors to practice telemedicine with a variety of platforms in light of the COVID-19 pandemic has provided insight into the difficulties in implementing and obtaining access to telemedical visits. To ensure that our most vulnerable patients (those who rely on home health visits) will have access to virtual outpatient care, we aim to enlist medical students in outreach to patients to help them set up various technology platforms or better understand how virtual visits take place prior to their scheduled visit. Lastly, we plan to survey patient, student, and preceptor satisfaction with virtual encounters, to further develop our telemedicine curriculum and implementation for the future.

Educación médica en tiempos de pandemia por SARS-CoV2

“…La estrategia más descrita para los campos de práctica es el fortalecimiento de los servicios de telemedicina y la participación de los estudiantes en ellos (26,33,37,56) incluyendo las rondas clínicas (telerronda) (47,72). Otras estrategias definidas son: organización de las prácticas haciendo énfasis en procedimientos con menos volumen o más dificultad para los residentes (52), creación de salas de cohortización para los pacientes sospechosos y confirmados sin acceso al personal en formación (73), realización de tutoría virtual durante cirugía para reducir el número de personas dentro del quirófano (74), no ingresar al quirófano durante la intubación orotraqueal, limitar el uso del electrocauterio (36), aumentar horarios de consulta ambulatoria para prevenir tumultos (75).…”

Experiencia en tiempos de pandemia

“…A lo largo de esta experiencia, también hemos tenido una primera toma de contacto con las diferentes realidades humanas, identificando un gran número de situaciones de vulnerabilidad psicológica o social, pues las desigualdades sociales se han visto acrecentadas en estos momentos (24)(25). En algunos casos, el entorno familiar y social era complejo, pues con frecuencia se trataba de personas de edad avanzada con escasos recursos y escaso soporte familiar.…”

“…Hay que tener en cuenta también las limitaciones que este seguimiento telefónico presenta (25). La exploración física se ve reducida a parámetros que pueden medirse fácilmente en casa por los propios pacientes por medio de pulsioxímetros, tensiómetros, termómetros o glucómetros.…”