Hands Off Yet All In: A Virtual Clerkship Pilot in the Ambulatory Setting During the COVID-19 Pandemic

Acad Med. 2021 Apr 20. doi: 10.1097/ACM.0000000000004127. Online ahead of print.

Abstract

Problem: There is a paucity of guidance regarding implementation of telemedicine curricula at the clerkship level, particularly with students actively engaged in video and telephone encounters. The COVID-19 pandemic caused rapid shifts in the delivery of medical education to clerkship-level students. This article describes the successful pilot of a direct patient care, virtual health curriculum at the clerkship level and discusses lessons learned.

Approach: All 18 preceptors and 5 students at Stanford University School of Medicine, California, enrolled in the required 4-week family medicine clerkship in April 2020 were connected as virtual partners via a commercial video platform. The combined use of both this video program and Epic electronic health record (EHR) software as modes for teaching and patient care led to technical challenges and logistical hurdles. As part of an iterative process, clerkship leadership identified problems via preceptor and student interviews and integrated that feedback in order to create a model for delivering high-quality, clerkship-level clinical instruction during the COVID-19 shelter in place order.

Outcomes: Of those who completed an evaluation, the majority of preceptors (n = 16; 89%) and students (n = 4; 100%, 1 student did not respond) expressed satisfaction with the virtual, remote teaching model conducted over 37 clinic visits. A detailed 14-step process list resulted from identifying and addressing both audio and video technical challenges and is provided for use by other institutions that wish to implement this workflow.

Next steps: Future directions include assessing patient perspectives on the involvement of students in virtual visits, soliciting patient input for a more robust patient-physician-student virtual experience, and integrating a multi-party platform, when available, via the EHR to afford greater student autonomy.