Zooming-out COVID-19: Virtual clinical experiences in an emergency medicine clerkship.

WHAT PROBLEMS WERE ADDRESSED?

Emergency medicine (EM) is a required clerkship for medical students in our medical college. During this rotation, students play an integral role in interviewing patients, formulating treatment plans and counselling patients. Immediately available direct and indirect supervision is paramount to ensure student learning and safe patient care.

In the setting of extricating students from the clinical learning environment amidst the coronavirus disease 2019 (COVID‐19) pandemic, it has been difficult to provide medical students with meaningful clinical experiences that meet clinical learning objectives. Here, we present a novel clinical educational experience for senior medical students in the form of clinical callbacks that provide students the opportunity to interact live with patients. Specific learning objectives addressed through this intervention were focused on Patient Care and Interpersonal and Communication Skills.

WHAT WAS TRIED?

After reviewing the electronic health record (EHR) with a faculty preceptor, students made calls to patients through a videoconferencing tool Zoom™ (Zoom Video Communications Inc., San Jose, CA, USA). Students identified patients to call back from two pools. The first consisted of patients who were treated and discharged from the Emergency Department (ED) by providers who eventually tested positive for COVID‐19. Although the ED providers were asymptomatic at the time of care, testing was ordered as soon as symptoms presented (per protocol). Students were provided with a script and checklist to guide virtual encounters. Follow‐ups fulfilled a departmental need, as well as providing students with an experience that reinforced learning objectives. The second pool included patients previously evaluated in the ED with general medical complaints and discharged within the previous 48 hours.

All virtual encounters were under direct supervision of a faculty preceptor. To minimise exposure risk, faculty preceptors and students were at their respective homes. Using a HIPAA (Health Insurance Portability and Accountability Act)‐compliant Zoom account, faculty preceptors connected with students and reviewed the EHR prior to the encounter. Each student reviewed the chart and verbally presented the patient before the call. The student then led a call to the patient, which was made through Zoom. Faculty preceptors supervised and listened to the conversation and provided feedback and comments to the students through the chat function of the software, in real time, and intervened when necessary. After the call, students assisted with documenting these callbacks. Faculty preceptors assessed students' performance with the same evaluation tools as the traditional clerkship.

Per the standard curriculum, non‐clinical learning objectives (eg, medical knowledge) were addressed through other pedagogical approaches (eg, virtual simulations, online didactics).

WHAT LESSONS WERE LEARNED?

There were 67 students who participated in this experience. One challenge encountered was the varying degree of success with patients answering calls. To address this, faculty preceptors had to keep a longer roster of patients for callbacks.

Students have provided overwhelmingly positive feedback. Students felt engaged and valued the help they provided to the ED during the COVID‐19 pandemic. Students appreciated the breadth of chief complaints treated in the ED and also valued the opportunity to work through clinical reasoning with the supervising faculty preceptor. Patients were grateful for the follow‐up. Faculty preceptors who completed the virtual follow‐ups also appreciated the ability to continue to teach students clinically, one‐on‐one, in a virtual setting that supported learning.