More than once, I have joked with my medical student leader that I look forward to the day when she will be my boss. I have mentored hundreds of health professions students over the past ten years. Teaching young thought leaders to address complex issues is rewarding and rejuvenating; it only seemed natural to incorporate these learners during the coronavirus pandemic.
COVID has disrupted the education of health professions students; indeed, the American Association of Medical Colleges recommended suspension of clinical rotations for students. Medical and health professional schools quickly modified existing curricula to adapt to the virtual environment for clinical students; additional volunteer opportunities such as student-run free clinics, have largely been placed on hold or modified extensively as well.
However, as our future caretakers and leaders, I would argue that it has been critical to have our learners engaged in patient care – as early adaptors and decision-makers – and we need to support – and expand – these pilot efforts, particularly in the most challenging patient areas.
Indeed adaptation is crucial these days; I have gone from practicing primary care in a working-class community of refugees and immigrants to seeing suspected COVID patients in a respiratory illness clinic while simultaneously figuring out telemedicine visits literally overnight. I practice in Chelsea, the epicenter of the pandemic in Massachusetts, with infection rates of 6,403 per 100,000.
At my clinic, we opened a respiratory illness clinic (RIC) in order to assess patients with respiratory symptoms safely in the outpatient setting, protecting healthcare staff while minimizing potential disease spread to other patients. In the past several months, the volume of patients seen in the RIC had initially increased exponentially, with hundreds coming in over the course of a day for evaluation. Patients receive follow up calls several follow up calls as both disease progression, and social concerns are identified throughout the course of illness. Given the recognition of disease severity and rapidity of diagnosis and illness in our community, it was clear providers would need assistance with surveilling the ever-growing follow-up queue. Students wanted to help providers with patient care follow up. Within hours of being asked to assist us with follow up phone calls in Chelsea, over 150 students came together to join our team as integral members.
How did we do it? Students organized themselves into twelve hours shifts, seven days a week of a senior student overseeing a group of four junior students; the rotating groups report to a dedicated faculty member each day. Scripted telephone outreach is performed and then documented; a manual authored by the students is updated daily. Patients with escalating concerns are brought in for further evaluation and also referred for social service needs.
Did we set up a rigorous, formally evaluated, years-in-the-making, tried and true telemedicine curriculum? No. Did we innovate on the fly in the poorest and most devastated community in the state, freeing up time for our providers to attend to other clinical needs? Yes.
Since overseeing this effort, I have learned that perfection truly is the enemy of progress; in a pandemic where the rules change every day, where job descriptions are laughable, we must make room for new roles and yet remember the key players in our education system who are sometimes the best innovators. Our students set up a system that has allowed 500 calls a week to our community; they have learned how to stretch their clinical acumen in a supported virtual environment. We don’t have time to build all the systems to perfection – rather, it is time to bring our learners right along with us on the journey.
“Thank you for having your student call me,” one of my patients told me in Spanish this week during a follow-up telemedicine visit. She recounts that her cough is better and that her eye pain has finally improved, two weeks into her COVID course. “I enjoyed speaking with her.”
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