A Student in My Pocket: Development of a Virtual Internal Medicine Hospital Rotation During the COVID-19 Pandemic.

Abstract

Purpose: It is imperative for physician assistant (PA) students to be exposed to hospital medicine as 40% of practicing PAs identify the hospital as their principal clinical practice setting. 1 Many of these rotations were canceled due to the COVID-19 pandemic, negatively impacting the 70% of PA programs not affiliated with an academic medical center. 2 To address this need and provide a comparable experience for PA students, medical educators at the University of Chicago created a Virtual PA Rotation (VPAR). The purpose of this project was to develop a high-yield clinical rotation for private PA programs negatively impacted by COVID-19 by implementing and evaluating a 4-week-long VPAR comprising (1) direct patient care, (2) medical educator-facilitated breakout sessions, and (3) asynchronous learning. Approach: Five students worked with 3 preceptors for the VPAR and were assigned 3–6 patients daily. Direct patient experiences included virtual interviews using FaceTime, preceptor staffing via Zoom, and completion of daily progress notes. This was augmented with medical educator-facilitated breakout sessions and didactic sessions. Evaluation of the VPAR included: (1) comparison of virtual vs traditional in-person rotation patient logs, (2) postcurriculum survey of students and medical educators’ satisfaction and self-efficacy, and (3) student pass rate on the end of rotation (EOR) examination. Outcomes: Diagnoses and patient encounter logs were collected from the 5 virtual rotation students and compared with 4 students who completed traditional in-person rotations in 2019–2020. Mean diagnoses logged per virtual student was 206 (standard deviation [SD] = 155), compared with mean 414 diagnoses (SD = 130) for traditional students (t = 2.14, P = .07). Mean patient encounters logged per virtual student was 34.2 (SD = 20.7), compared with 80.8 (SD = 29.5) for traditional students (t = 2.79, P = .03). One hundred percent of students responded to a survey. Interactive patient interviews, preceptor group, case presentations, and electronic health record review were rated as the most useful educational experiences. Students felt most prepared in ability to review hospital charts, analyze results, and obtain a patient history. All 5 students felt this rotation provided an adequate experience to understand Internal Medicine in a hospital setting. Fifty-nine percent (13/22) of medical educators responded to the postrotation survey. Eighty-five percent (11/13) were moderately or extremely satisfied with their participation in teaching in the rotation, 77% (10/13) were moderately or extremely likely to recommend the rotation to other medical educators, and 100% felt it made them more open to future interprofessional education experiences. Discussion: We were able to create an innovative, high-yield hospital medicine rotation to meet the need for PA students negatively impacted by COVID-19. The VPAR overall was a success as measured by 100% EOR examination pass rate, high student ratings, and comparable patient encounters and diagnoses. The VPAR was also well received by medical educators, though most felt it was more time-consuming, proving to be the biggest limitation to this model. Lessons learned from the preceptors included limitations of technology such as decreased device battery life, need for troubleshooting, and loss of organic educational experiences for students. They also highlighted concerns regarding increased time dedicated to logistics of the rotation while managing highly complex patients. Strengths of the VPAR include its feasibility, low cost of implementation, and ease of application of this model to other practice settings, specialties, and professions. The VPAR also has the capability to adjust for different rotation lengths of time. Significance: We believe the results above showcase that this innovative model of education can meet the needs of PA students negatively impacted by COVID-19. Therefore, as COVID-19 continues and health systems respond, a VPAR is a reasonable alternative to in-person clinical rotations. Beyond COVID, this pilot rotation’s success demonstrates that VPARs or a hybrid of a virtual and in-person rotation may be an interesting addition to PA education, particularly for unaffiliated programs with a significant need for access to inpatient rotations and tertiary care centers. Furthermore, this model could easily translate to other professional disciplines similarly impacted by visiting student restrictions.