Medical student support for vulnerable patients during COVID-19 – a convergent mixed-methods study

Abstract

Background The coronavirus pandemic has exerted significant impacts on primary care, causing rapid digital transformation, exacerbating social isolation, and disrupting medical student and General Practice [GP] trainee education. Here we report on a medical student telephone initiative set-up by a final year GP trainee (the equivalent of a family medicine resident), which aimed to support patients at high risk and vulnerable to the Coronavirus Disease of 2019 [Covid-19]. In addition, it was hoped the project would mitigate a digital divide, enable proactive anticipatory planning, and provide an active learning environment to compensate for the pandemic’s impact on medical education. Methods Thirty-three medical students conducted daily telephone conversations with high risk and vulnerable patients as specified by the initial NHSE published lists. They confirmed public health messages, offered details for voluntary support groups, established need for medication delivery, explored levels of digital connectivity, and prompted discussions around end-of-life choices. Students had access to online reflective resources and daily remote debriefing sessions with the GP trainee. A convergent mixed-methods evaluation was subsequently undertaken, using quantitative process and descriptive data and individual qualitative interviews were conducted according to a maximal variation sampling strategy with students, General Practitioners [GPs], and the GP trainee. Inductive thematic analysis was then applied with cross-validation, respondent validation, and rich evidential illustration aiding integrity. Results Ninety-seven ‘high risk’ and 781 ‘vulnerable’ calls were made. Individuals were generally aware of public heath information, but some struggled to interpret and apply it within their own lives. Therefore respondents felt students provided additional practical and psychological benefits, particularly with regard to strengthening the links with the community voluntary groups. The project was widely liked by students who reported high levels of skill development and widened awareness, particularly valuing the active learning environment and reflective feedback sessions. Conclusion This study demonstrates utilization of medical students as wider assets within the primary health care team, with an initiative that enables support for vulnerable patients whilst promoting active medical education. Ongoing integration of students within ‘normal’ primary health care roles, such as chronic disease or mental health reviews, could provide similar opportunities for supported active and reflective learning.

Impact of COVID-19 on the digital divide: a rapid review

“…One study looked at digital access; set in UK primary care it explored internet connectivity among vulnerable patients (including those who have received an organ transplant, are undertaking immunotherapy or an intense course of radiotherapy for lung cancer). 38 39 It was also one of the seven studies that looked at digital literacy 39 alongside five studies set in the USA that explored the use of digital technologies in accessing care among different ethnic groups [40][41][42][43][44] and one study conducted in Italy that looked at the age and gender of patients using telemedicine. 45 Two studies were concerned with digital assimilation, one set in Italy described the social support gained from using video messaging platforms 46 and a second again set in the USA explored the characteristics of individuals posting COVID-related content on social media.…”

“…It was conducted in UK primary care as part of a study whose overall aim was to explore whether vulnerable patients might be usefully supported by telecoaching in the use of digital health technologies, in this Open access Open access instance by general practitioner trainees. 39 As part of these conversations a direct question was asked around internet connectivity and the authors reported that 22% of high-risk patients and 44% of vulnerable patients reported issues. 39 Digital literacy A total of seven studies addressed the domain of digital literacy and in particular an individual's digital skill set, specifically in relation to the ways in which they accessed care.…”

“…39 As part of these conversations a direct question was asked around internet connectivity and the authors reported that 22% of high-risk patients and 44% of vulnerable patients reported issues. 39 Digital literacy A total of seven studies addressed the domain of digital literacy and in particular an individual's digital skill set, specifically in relation to the ways in which they accessed care. All provided comparisons of use between groups using of demographic characteristics that included age, gender and ethnicity.…”

“…45 In relation to self-efficacy, the Hughes et al's study set in the UK also assessed vulnerable patients' confidence and ability to order medications online and reported they were comfortable and confident with the process. 39…”

“…We identified nine studies that explored various constructs within the three domains of our digital divide framework. In relation to digital access, poor internet access among the elderly was reported 39 ; as regards digital literacy lower levels of take-up of telemedicine among certain communities in the USA were described particularly among black and Hispanic patients. [41][42][43][44] Within the domain of digital assimilation one study described how face-time technology can sustain relationships among dislocated peer groups, 45 and another how black and elderly males, previously considered a group unprepared to share health information on social media platforms, were the demographic most likely to post content on the pandemic, an Open access important consideration in understanding the emerging scepticism of the COVID-19 vaccine in ethnic groups.…”