An outpatient telehealth elective for displaced clinical learners during the COVID-19 pandemic
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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.
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SciScore for 10.1101/2020.07.28.20146522: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Their verbal consent to participate in telehealth services is obtained and students proceed with the patient encounter thereafter. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources When attending physicians request student support, a Microsoft Excel workbook is populated with their contact information and deidentified appointment times in half-day increments. Microsoft Excelsuggested: (Microsoft Excel, RRID:SCR_016137)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to …
SciScore for 10.1101/2020.07.28.20146522: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Their verbal consent to participate in telehealth services is obtained and students proceed with the patient encounter thereafter. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources When attending physicians request student support, a Microsoft Excel workbook is populated with their contact information and deidentified appointment times in half-day increments. Microsoft Excelsuggested: (Microsoft Excel, RRID:SCR_016137)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Despite the limitations presented, the outcomes of this pilot highlight a workflow that enables students to meaningfully participate in patient care within the telehealth setting. Our efforts have since expanded to include 100 rising second-year medical students. With these additional pre-clinical participants, the telehealth elective has serviced over 2000 patients from the RWJMS outpatient practices. As patient volumes stabilize in the outpatient clinics, the focus of the elective will shift towards education through several modifications. For example, we plan to increase the number of students assigned to each attending physician and schedule explicit debrief sessions. This modification will maintain the practical aspects of the elective, increase uniformity among student experiences, and guarantee educational moments. To ensure student exposure to various patient populations, we will share our presented workflow with several specialty clinics that have already expressed interest in conducting a similar telehealth elective. We will continue to develop different and exciting modifications to bridge the return of learners to the clinical space. After a successful four-week pilot of our outpatient telehealth elective, we started developing an inpatient telehealth initiative based on the Yale iCollaborative resources.3 This initiative will allow medical students to contribute to inpatient care remotely as practices and hospitals gradually reopen. The primary objective of this ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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SciScore for 10.1101/2020.07.28.20146522: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Their verbal consent to participate in telehealth servic is obtained and students proceed with the patient encounter thereafter. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources When attending physicians request student support, a Microsoft Excel workbook is populated with their contact informatio and deidentified appointment times in half-day increments. Microsoft Excelsuggested: (Microsoft Excel, SCR_016137)Data from additional tools added to each annotation on a …
SciScore for 10.1101/2020.07.28.20146522: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Their verbal consent to participate in telehealth servic is obtained and students proceed with the patient encounter thereafter. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources When attending physicians request student support, a Microsoft Excel workbook is populated with their contact informatio and deidentified appointment times in half-day increments. Microsoft Excelsuggested: (Microsoft Excel, SCR_016137)Data from additional tools added to each annotation on a weekly basis.
About SciScore
SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.
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