The COVID-19 Pandemic as an Opportunity for Operational Innovation at 2 Student-Run Free Clinics

Abstract

The onset of the COVID-19 pandemic and subsequent county shelter-in-place order forced the Cardinal Free Clinics (CFCs), Stanford University’s 2 student-run free clinics, to close in March 2020. As student-run free clinics adhering to university-guided COVID policies, we have not been able to see patients in person since March of 2020. However, the closure of our in-person operations provided our student management team with an opportunity to innovate. In consultation with Stanford’s Telehealth team and educators, we rapidly developed a telehealth clinic model for our patients. We adapted available telehealth guidelines to meet our patient care needs and educational objectives, which manifested in 3 key innovations: reconfigured clinic operations, an evidence-based social needs screen to more effectively assess and address social needs alongside medical needs, and a new telehealth training module for student volunteers. After 6 months of piloting our telehealth services, we believe that these changes have made our services and operations more robust and provided benefit to both our patients and volunteers. Despite an uncertain and evolving public health landscape, we are confident that these developments will strengthen the future operations of the CFCs.

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 ].…”

“… 1,2,3,4,8,9 Comm FM US Peterseim and Watson [ 21 ] Telehealth clinic shadowing family medicine attending or student led e-consultation taking history and describing physical exam manoeuvres to patient to perform on themselves. 4,6,8,9 Comm FM US Ruiz Colon et al [ 22 ] Students performed history taking, delivery of patient education and counselling after receiving basic telehealth training. 2,4,5 Comm FM US Darnton et al [ 23 ] a pre-clinical students already educated in basic clinical communication and exam skills consulted from own home whilst supervised by primary care physician in three-way telemedicine clinic.…”

“…Similar pilot programs were reported by family medicine telehealth clinics at the Medical University of South Carolina [ 21 ]. A unique program led by Stanford University’s students, called Cardinal Free Clinics, opened immediately after the onset of the pandemic, and changed to a telehealth clinic model when in-person patient clinics were forced to close due to university COVID-19 policies [ 22 ]. In the UK, Darnton et al [ 23 ] used telemedicine for teaching pre-clinical medical student in the community.…”

“… NA commentary NA Pennell et al [ 32 ] Live-streamed ward rounds: a tool for clinical teaching during the COVID-19 pandemic Med J Aust GB 2020 Clinical Univ O&G Online real Ward round, Clinial case discussions, Interactive Q&A 1 original article Cross-sectional; survey Peterseim and Watson [ 21 ] Family Medicine Telehealth Clinic With Medical Students PRiMER US 2020 Clinical Com FM online™ real Telehealth clinic shadowing family medicine attending or student led econsultation taking hisotry and describing physical exam manoeuvres to patient to perform on themselves. 2b original article Case control comparsion; performance test(MCQ) Roskvist et al [ 56 ] Provision of e-learning programmes to replace undergraduate medical students' clinical general practice attachments during COVID-19 stand-down Educ Prim Care NZ 2020 Clinical Com FM Online clinical scen e-learning interactive, podcasts, videos, academic papers NA short report NA Ruiz Colón et al [ 22 ] The COVID-19 Pandemic as an Opportunity for Operational Innovation at 2 Student-Run Free Clinics J. Prim. Care Comm Heal US 2021 …”