Abstract
This article was migrated. The article was marked as recommended. COVID-19 has disrupted traditional forms of clinical practice in both inpatient and outpatient settings. This novel, potentially-fatal infection proliferated to such a degree that many patients with mild disease had to engage in self-care at home. This disruption to clinical services has also upended in-person clerkship education across the country, leading to sustained periods of student furloughing. We developed a telehealth service-learning opportunity for COVID-19 patients who were advised to self-care in their homes. The service was staffed by medical students in their clinical training years, providing triage advice to patients, their families, and co-habitants until their symptoms improved. Callers set patient education around red flag symptoms as their first priority, but also offered counsel on home infection control and self-isolation strategies, composed work letters, offered resources regarding home management issues such as food and sanitation, and attended to the mental health needs of the patients and their families. An attending was on-call daily to assist and educate students about issues relating to clinical decision-making and the social determinants of health. A survey assessed medical students' opinions on the service. Student respondents found the service valuable, with 100% agreeing or strongly agreeing that the service was worth their time and important. Respondents reported learning important telehealth skills such as triage and patient education. Overwhelmingly, students found emotional connections with patients to be the most meaningful aspects of the service. Our telehealth service allowed students to learn from patients in a longitudinal manner, while remaining safely away from clinical settings. This service may prove a useful model for others in the case of another outbreak, particularly when medical students are furloughed. We hope to develop more clinical experiences in telehealth for medical students moving forward.
Highlights
On April 14, the American Association of Medical Colleges (AAMC) "strongly suggest[ed] that medical students not be involved in any direct patient care activities" in COVID-19 hotspot areas, due to limited amounts of personal protective equipment and undue exposure for students, people in their social circles, and patients themselves (Whelan et al, 2020)
We developed a telehealth service-learning opportunity for COVID-19 patients who were advised to self-care in their homes
In March and April, COVID-19 cases exploded across the country, and UChicago Medicine saw precipitous increases in the number of patients at its Emergency Department and its drive-thru testing facility presenting with symptoms of Influenza-like illness (ILI) with concern for COVID-19
Summary
On April 14, the American Association of Medical Colleges (AAMC) "strongly suggest[ed] that medical students not be involved in any direct patient care activities" in COVID-19 hotspot areas, due to limited amounts of personal protective equipment and undue exposure for students, people in their social circles, and patients themselves (Whelan et al, 2020). That leader distributed new patients on that list among their team members, and student volunteers followed with those patients until designated "complete". On the first call with a patient, volunteers reviewed the EMR and took a targeted history related to the patient’s COVID-19 course On this first call, in addition to history-taking meant to better risk-stratify patients (history of hypertension, lung disease, obesity, other conditions associated with moderate/severe COVID-19), patient education was offered, outlining up-to-date guidelines for effective self-isolation, safe use of anti-pyretics, and most importantly, red flag symptoms which would prompt a visit to the ED.
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