Engaging Third-Year Medical Students on Their Internal Medicine Clerkship in Telehealth During COVID-19
Engaging Third-Year Medical Students on Their Internal Medicine Clerkship in Telehealth During COVID-19
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DOI：
10.7759/cureus.8791
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发表时间：
2020-06-24
影响因子：
1.2
通讯作者：
Levine, Diane L.
中科院分区：
文献类型：
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作者：
Abraham, Heather N.;Opara, Ijeoma N.;Levine, Diane L.
目的：由于冠状病毒病（COVID-19）全球大流行，美国医学院协会（AAMC）建议医学生不要接触COVID-19检测阳性或疑似患者（PUI）。由于底特律是一个高度受影响的地区，韦恩州立大学（WSU）的医学生在这段时间内被分配到医院实习，基本上无法进行任何直接的病人护理活动。为内科（IM）见习的模型开发了一个临床远程医疗组件，以创造一个安全的环境，让学生继续进行有意义的病人护理。目标：为了模拟一个课程，使学生有一个多样化的病人护理经验，同时提高他们的技能和信心，在远程保健的性能，参与者人数：20名三年级医学生，在学年结束时被分配到底特律医学中心的IM见习工作。方法：学生们被指示完成美国医师学院（ACP）远程医疗模块，通过临床教师的Zoom在线平台进行定向，并被安排在每周的远程医疗诊所时间表上，由IM的居民和主治医生进行指导。调查数据收集，涵盖学生的知识，技能和态度周围的远程保健在旋转的开始。与见习主任举行了一次见习中期反馈会议，并对由此产生的定性数据进行了评估，以便与基线评估进行比较。确定前和后的评估报告之间的增量变化将在完成的见习，该数据cominguishing.Results：基线调查显示，90%的学生认为远程医疗的经验将是一个宝贵的除了他们的IM见习。大多数人相信，通过培训，他们可以有效地完成远程医疗访问，80%的人认为远程医疗将在他们未来的职业生涯中发挥重要作用。学生们对远程医疗访问物流以及他们在Zoom在线平台上积极协助患者方面的作用感到满意。尽管在开始远程医疗体验之前，学生们最初对与患者有效沟通感到焦虑，但他们在这方面表现出了一种共同的趋势。学生们对住院医生和主治医生通过虚拟平台表达同情心的指导量印象深刻。总的来说，学生们对所看到的各种病例以及远程医疗接触后从住院医生和主治医生那里得到的及时反馈感到满意。在中期评估，学生表示满意的整体经验，并赞赏的机会，继续与病人互动，尽管限制的流行imposed.Conclusions：很少正式教授远程医疗无论是在医学院或医疗住院医师，并纳入正式课程是罕见的。AAMC正在开发远程医疗的能力，一旦发布，这种形式的教学将成为一种期望。我们成功开发了一个强大的模型，医学生不仅积极参与，而且还积极为患者提供远程医疗保健。
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 pandemic imposed.Conclusions: Little is formally taught about telehealth in either medical school or medical residency, and integration into a formal curriculum is rare. The AAMC is underway with the development of competencies for telehealth, and, once released, the teaching of this format will become an expectation. We successfully developed a robust model in which medical students not only actively participated in, but also actively delivered, telehealth care to our patients.