An outpatient telehealth elective for displaced clinical learners during the COVID-19 pandemic

Abstract

Background: In response to the COVID-19 pandemic, medical schools suspended clinical rotations. This displacement of medical students from wards has limited experiential learning. Concurrently, outpatient practices are experiencing reduced volumes of in-person visits and are shifting towards virtual healthcare, a transition that comes with its own logistical challenges. This article describes a workflow that enabled medical students to engage in meaningful clinical education while helping an institution's outpatient practices implement remote telemedicine visits.

Methods: A 4-week virtual elective was designed to allow clinical learners to participate in virtual telemedicine patient encounters. Students were prepared with EMR training and introduced to a novel workflow that supported healthcare providers in the outpatient setting. Patients were consented to telehealth services before encounters with medical students. All collected clinical information was documented in the EMR, after which students transitioned patients to a virtual Doxy.me video appointment. Surveys were used to evaluate clinical and educational outcomes of students' participation. Elective evaluations and student reflections were also collected.

Results: Survey results showed students felt well-prepared to initiate patient encounters. They expressed comfort while engaging with patients virtually during telemedicine appointments. Students identified clinical educational value, citing opportunities to develop patient management plans consistent with in-person experiences. A significant healthcare burden was also alleviated by student involvement. Over 1000 total scheduled appointments were serviced by students who transitioned more than 80 % of patients into virtual attending provider waiting rooms.

Conclusions: After piloting this elective with fourth-year students, pre-clerkship students were also recruited to act in a role normally associated with clinical learners (e.g., elicit patient histories, conduct a review of systems, etc.). Furthermore, additional telemedicine electives are being designed so medical students can contribute to patient care without risk of exposure to COVID-19. These efforts will allow students to continue with their clinical education during the pandemic. Medical educators can adopt a similar workflow to suit evolving remote learning needs.

Keywords: COVID-19; Coronavirus pandemic; Outpatient clinic; Remote learning; Telemedicine elective.

Fig. 1

Outpatient Workflow for Virtual Telehealth Patient Encounters. Swimlane diagram of the outpatient workflow developed in coordination with RWJMG practice managers

Fig. 2

Metrics of Medical Student Comfort with Patients. Students reported their comfort engaging with patients by indicating their ability to (a) make a personal connection with the patient, (b) explore the patient’s perspective of their illness, (c) determine the accuracy of the patient’s understanding

Fig. 3

Metrics of Medical Student Engagement with Clinical Outpatient Practices. Trend of total scheduled telehealth appointments over a four-week period (April 13 to May 8) for RWJMG specialty clinics (internal medicine, pediatric, and neurology). All patient encounters successfully transitioned to a Doxy.me video call (dark blue) are illustrated as a percentage of initiated patient encounters (light blue)

Fig. 4

Barriers to Successful Telehealth Utilization. Student survey responses that quantify instances where students were unable to (a) initiate the patient encounter and (b) transition initiated patient encounters to a Doxy.me video call