Remote Learning in the Time of COVID-19.

With the spread of SARS‐CoV‐2 in the United States, medical schools across the nation have taken measures to protect the health and safety of their students. Notably, most schools have elected to suspend clinical experiences for medical students as the pandemic evolves. Many schools have demonstrated creativity and adaptability by developing online, nonclinical electives for their students to engage in. Here, we provide an easily implemented opportunity for remote clinical learning in the time of COVID‐19 in the emergency department.

REMOTE LEARNING PROCESS

This process affords students the opportunity to practice history taking, differential diagnosis, clinical reasoning, and patient management skills from a remote setting (Figure 1). A student will be assigned to a resident or attending and will be available by cell phone, tablet, or other communication device when that physician is working. The resident or attending will contact the student prior to the shift and set a time period when a patient will be identified for the student to interview. Ideally, the student will also have remote access to the electronic medical record for chart review. Low‐volume or fast‐track shifts likely will be most amenable to this scheme.

Figure 1

Remote learning instructions.

During the session, the student performs iterative differential diagnosis formulation, as described in other medical education schemes. The Clinical Reasoning and Differential Diagnosis Sheet (Figure 2) is a helpful tool to guide clinical reasoning. Figure 3 demonstrates a completed version based on a remote learning case regarding a 45‐year‐old healthy male presenting with 2 weeks of lower back pain with bilateral sciatica after an episode of heavy lifting and with a recent history of rollover motor vehicle collision.

Figure 2

Clinical Reasoning and Differential Diagnosis Worksheet. Adapted from Mamede et al.

Figure 3

Example of a completed Clinical Reasoning and Differential Diagnosis Worksheet.

At the end of the remote session, the physician and student should review concepts learned during the session and provide feedback. Assessment and teaching of clinical reasoning can be integrated into the case presentation through clinician verbalization of their own thought process.

CONCLUSION

As the pandemic continues to evolve, identifying and implementing opportunities to provide some form of clinical continuity and education for medical school learners will be of high value. This simple scheme provides for real‐world case practice from a remote setting in the current (and likely recurrent) event that learners are not permitted in the direct clinical environment. In a time demanding adaptability and creativity, we believe this process offers a reasonable model of clinical learning and a valuable engagement for learners.