Engaging Third-Year Medical Students on Their Internal Medicine Clerkship in Telehealth During COVID-19

Abstract

Purpose: Due to the coronavirus disease-19 (COVID-19) global pandemic, the Association of American Medical Colleges (AAMC) recommended that medical students be removed from contact with patients testing positive or patients under suspicion (PUIs) for COVID-19. As a result of Detroit being a highly affected area, the Wayne State University (WSU) medical students assigned to hospital clerkships during this time were essentially prevented from performing any direct patient care activities. A model for the Internal Medicine (IM) clerkship was developed incorporating a clinical telehealth component, in order to create a safe environment for students to continue to perform meaningful patient care. Objectives: To model a curriculum whereby students have a diverse patient care experience while increasing their skill and confidence in the performance of telehealth, as measured by self-report in a required pre- and post-clerkship assessment. Participant population: Twenty, third-year medical students at the end of their academic year, assigned to the IM clerkship at the Detroit Medical Center. Methods: Students were instructed to complete the American College of Physicians (ACP) module on telehealth, given an orientation via the Zoom online platform by clinical faculty, and placed on a weekly telehealth clinic schedule, precepted by residents and attendings in IM. Survey data was collected covering students’ knowledge, skills, and attitudes surrounding telehealth at the beginning of the rotation. A mid-clerkship feedback session was held with the clerkship director, and the resultant qualitative data was assessed for themes to be compared against the baseline assessment. Determination of incremental change between pre- and post-assessment reports will be evaluated at the completion of the clerkship, with that data forthcoming. Results: Baseline survey revealed that 90% of students believed the telemedicine experience would be a valuable addition to their IM clerkship. Most were confident that, with training, they could effectively complete a telemedicine visit and 80% felt that telehealth would play an important role in their future careers. Students were pleased with the telemedicine visit logistics and with their role in actively assisting patients with the Zoom online platform. Despite initial anxiety over effectively communicating with patients prior to beginning the telemedicine experience, students demonstrated a common trend towards comfort with that aspect of the visit. Students were impressed with the amount of guidance given by resident and attending physicians in expressing empathy via a virtual platform. Overall, students were pleased with the variety of cases seen and the prompt feedback they received from resident and attending physicians after the telemedicine encounters. At the midpoint assessment, students expressed satisfaction with the overall experience and appreciated the opportunity to continue interacting with patients despite the limitations the pand...

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“…Consider with the student what can be gleaned from the encounter: how the patient tells their story; aspects of the history that help build the differential diagnosis; which data are available from wearable devices; or what findings can result from the "Telehealth Ten," a patient-assisted clinical examination to help guide providers in their physical examination and clinical reasoning over telemedicine [28]. Clerkship students have noted that they appreciate timely feedback during the telehealth encounter or right after the visit, and virtual exam skills observation allows for a focused discussion around behaviors the student can keep, start, or stop doing [14]. During the visit, it may become clear that the symptoms discussed or signs noted in the virtual examination require transition to an in-person visit.…”

“…Whether you are working with a student for two sessions or twenty-two sessions, providing feedback in the moment based on your observations can help to stimulate the student's growth mindset and enhance the telehealth learning experience [52]. Having a feedback dialogue in a postsession online huddle without the patient present allows the teacher to share reinforcing and redirecting feedback based on their observations [14]. One potential structure for the postsession huddle is the "ask-tell-ask framework" [53].…”

“…However, much of the existing literature on telehealth for learners focuses on residents [3,8,9] or telehealth curricular descriptions for medical students [7,[10][11][12][13]. There is limited but growing literature on integrating medical students into telehealth visits [14][15][16][17].…”

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