188 Implementation of a Telemedicine Student Clinic

Abstract

As part of a curricular change, an academic medical center implemented a medical student telemedicine education clinic for first-year medical students in October 2020. By augmenting current AAMC and LCME compliant educational standards with a telemedicine clinic experience, preclinical medical students learned versatile patient-care skills that will be effective in both in-person and virtual clinic settings. This research describes the initial successes and challenges of implementing a pre-clerkship medical student telemedicine education clinic. This research is a process evaluation of the implementation of a pre-clerkship medical student telemedicine education clinic. Patients with two or more chronic diseases were recruited from affiliated primary care practices. Students worked in pairs to perform each of the curricular goals and objectives including: reviewing the patient’s electronic medical record (EMR) and care plan, interviewing patients via a telemedicine platform, and documenting patient interactions (including an assessment and plan) in the EMR. These patient encounters were not directly supervised by faculty. Immediately after the visit, students gave an oral presentation to on-site faculty, and provided a written note to the on-site faculty and the patient’s primary care physician. If a patient visit could not be completed, a standardized patient was utilized for the telemedicine visit. In order to evaluate the program, the following data were collected: number of patient contacts, visit outcomes (including completion/non-completion of the visit, successful/unsuccessful telemedicine utilization, adequacy or need for other types of connection, need/no need for intervention by the on-site faculty for an emergent or urgent medical issue), student surveys, and patient surveys. A total of 382 patients were contacted and 122 agreed to participate in a visit (32%). Since program initiation, 15 patients have been removed by their request or for more than two visit cancellations (13.4%), and two due to death (1.6%). In the first seven months of the clinic, students scheduled 573 visits of which 373 (65%) were successfully completed. The other 200 visits (35%) were cancelled by the patient or the patient did not connect for the visit. On-site faculty intervened in 14.3% of encounters for the following reasons: send to the emergency department 1.3%, urgent consult for specialty care 5%, 24-hour follow up with PCP 8%. Visit lengths varied as follows: 0-10 minutes 6.2%, 10-20 minutes 65%, 20-30 minutes 23.2%, >30 minutes 5.6%. Patient surveys demonstrate that 67.9% felt the student clinic would enhance communication with their primary care physician “a lot” to “a great deal.” Patients rated the student as “somewhat” to “extremely professional” for 87.5% of the visits. Students evaluated the experience as follows: Excellent 71%, Good 26%, Average 3%, Poor 0%. Student skill completion is listed in Table 1. This research demonstrates that the implementation of a preclinical telemedicine curriculum is possible (patients are willing to participate), provides an opportunity for skill development, and was viewed favorably by both patients and students. Preliminary data on patient retention and student satisfaction suggest that this is a sustainable model for developing telemedicine competencies in preclinical medical students.