SGIM Forum

From the Regions

Bridging the Gap: A COVID-19 Telehealth Pilot

Dr. Block (lblock2@northwell.edu) is an associate professor in the Department of Medicine and the Department of Science Education at the Zucker School of Medicine at Hofstra/Northwell and co-director of Patient, Physician, and Society at Zucker School of Medicine. Dr. Jayman-Aristide (razia.jayman-aristide@hofstra.edu) is an assistant professor in the Department of Medicine and the Department of Science Education at Zucker School of Medicine at Hofstra/Northwell and co-director of Ambulatory Clerkships at Zucker School of Medicine. Dr. Ahuja (taranjeet.ahuja@hofstra.edu; Twitter @DrAhuja) is an assistant professor in the Department of Pediatrics and the Department of Science Education at the Zucker School of Medicine at Hofstra/Northwell and co-leader of Communications at Zucker School of Medicine. Dr. Ginzburg (samara.ginzburg@hofstra.edu) is an associate professor in the Department of Medicine and the Department of Science Education at the Zucker School of Medicine at Hofstra/Northwell and associate dean for Case-Based Learning at Zucker School of Medicine.

The COVID-19 pandemic surge reduced the number of traditional clinical opportunities available to medical students. Concerns for student safety, rationing of PPE, and the reduction of ambulatory and elective health care utilized during the pandemic created a need to offer students alternative ways to engage in clinical medicine.1 At the same time, the dramatic increase in numbers of ill patients during the peak of the pandemic created the need for healthcare professionals to engage in infection control, testing, and management. Among these was the need for daily check-ins by primary care physicians with patients sick with COVID-19 using telehealth for support, management, and triage. With many primary care providers in New York deployed to urgent care and hospital medicine, ill themselves, or caring for sick family members, the increased demand for primary care services overwhelmed the limited supply of available primary care providers.2 Innovative roles for medical students in infection control, testing, and management may extend the healthcare workforce while providing education and social support for isolated patients.3 To both meet the needs of the patients for daily telephone care and provide students an opportunity to engage in clinical medicine at the height of the pandemic, we piloted a student telephonic check-in program for patients ill with suspected or confirmed COVID-19.

Participants and Setting

Five first- and third-year medical students engaged in a longitudinal ambulatory clerkship at one medical school in New York volunteered to call patients on a daily basis for four weeks during April 2020. Student volunteers were paired one-to-one with community physicians who were general internists employed by the large health system. Some of these students had pre-existing relationships with these preceptors and had been rotating through their offices before the onset of the pandemic.

Program Design

We trained students in use of the telehealth platform, the electronic medical record (EMR), and Centers for Disease Control and Prevention (CDC) and local guidelines for triage and care of patients with COVID-19.4 All students had an opportunity to practice telephonic clinical and communication skills remotely with feedback from preceptors and peers prior to initiating the pilot through a two-hour remote learning session. Feedback was focused on best practices in communication skills.5 Sessions with a simulated patient provided additional practice gathering histories and review of systems relevant to COVID-19, using empathic communication skills, triaging based on patient symptoms and vital signs, and referring to behavioral health and community resources. Preceptors were instructed to assign students one to five patients to call daily, aiming for continuity throughout the week where possible. Students and preceptors completed telephonic check-ins daily. Where needed, students followed up with patients after discussing the case with their preceptor, and preceptors called patients as needed to obtain additional information.

Evaluation

A pre- and post-pilot survey was sent to student and preceptors participants. The survey included multiple choice items on knowledge and skills, challenges, rewards of participation, and open-ended items on lessons learned and suggestions for future pilots.

Results

All five student-preceptor dyads remained in the pilot for four weeks. Students reported calling one to five patients daily. Neither preceptors nor students reported concerns about getting in touch with each other daily. All students reported the following: joining the pilot to learn telehealth skills and serve the community, learning about manifestations and management of COVID-19, finding the most meaningful part of participation was working with their preceptor and having patient contact, and feeling challenged by managing the experience and schoolwork. All students and preceptors hoped students would learn triage skills. While three of five preceptors joined the pilot to help students learn about COVID-19, all preceptors felt they had given students the opportunity to learn about COVID-19 following participation. All students and preceptors reported patients were open to having students call them daily. Four of five students commented on use of communication skills and empathy in response to an open-ended question on their lesson learned. All preceptors reported that medical students of any year were suited to participate. Two preceptors reported setting clear expectations for students including a daily check-in time as lessons learned. One student and one preceptor reported difficulties with EMR access delaying startup.

Lessons Learned

This pilot introduced medical students to telehealth assessment and management for patients ill with suspected COVID-19. A mentored experience and daily phone calls allowed for continuity, individualized instruction, sign-out, and feedback. Training prior to pilot initiation allowed for standardization of care and ensured students were prepared to begin work with preceptors as efficiently as possible. Students gained experience in use of the EMR that they will apply during subsequent clinical work.

The pandemic served as a catalyst for widespread use of telehealth service, including in medical education. New roles for medical students in infection control, testing, and management may extend the healthcare workforce while providing education and social support for isolated patients.5 Limitations of this pilot include a small sample size at one medical school and self-reported data. Next steps include a larger pilot including video assessment and evaluation of patient perceptions of student involvement in telehealth. A telehealth pilot pairing students with busy preceptors to check in on patients with COVID-19 enabled students to develop communication skills and skills in triage in a manner conducive to preceptor, students, and patient needs. Among the myriad changes to rendered by the COVID-19 pandemic, medical student participation via telehealth can be a valuable healthcare workforce extension.

References

  1. American Association of Medical Colleges. Important guidance for medical students on clinical rotations during coronavirus (COVID-19) outbreak. https://www.aamc.org/news-insights/press-releases/important-guidance-medical-students-clinical-rotations-during-coronavirus-covid-19-outbreak. Published March 17, 2020. Accessed November 15, 2020.

  2. Hollander JE, Carr BG. Virtually perfect? Telemedicine for COVID-19. N Engl J Med. 2020;382:1679-81.

  3. Center for Disease Control. Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html. Updated September 10, 2020. Accessed November 15, 2020.

  4. American College of Physicians. Telemedicine: A practical guide for incorporation into your practice. https://www.acponline.org/cme-moc/online-learning-center/telemedicine-a-practical-guide-for-incorporation-into-your-practice. Accessed November 15, 2020. (publication date unknown)

  5. Bauchner H, Sharfstein J. A bold response to the COVID-19 pandemic: Medical students, national service, and public health. JAMA. 2020;323(18):1790-91.


#2021
#January
#Regular

Tags and Keywords