Providing support in a pandemic: A medical student telehealth service for ambulatory patients with COVID-19.
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ABSTRACT:
SUBMITTER: Zhang A
PROVIDER: S-EPMC8758284 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundPrior to the COVID-19 pandemic, medical students exhibited poorer mental health relative to the general population and other students. This research aimed to assess American medical student mental health during the pandemic's height, while also identifying stressors and vulnerable populations.MethodsIn this cross-sectional study, 960 US allopathic and osteopathic medical students completed a mental health survey screening for depression, anxiety, burnout, suicidal ideation and increased substance use during the height of the COVID-19 pandemic. Potential relationships were explored between these mental health indicators and demographic and environmental factors, such as COVID-19 exposure.FindingsOf the 960 medical students surveyed, 25.1% (n = 241) screened positive for depression, 40.4% (n = 388) screened positive for anxiety, 21.3% (n = 201) met criteria for at least one dimension of burnout, 19.0% (n = 182) started or increased substance use and 7.2% (n = 69) experienced thoughts of self-harm or suicide. Significant differences (p ≤ 0.01) in measures of mental health were associated with those who had accessed mental health care, had a personal COVID-19 diagnosis, knew someone who died of COVID-19 or were female.ConclusionsAlthough rates of anxiety and substance use among medical students in our study were higher than previously reported, rates of burnout and thoughts of self-harm or suicide were surprisingly lower. These results indicate that some aspects of remote learning imposed by the pandemic could be protective, warranting additional study for post-pandemic medical education. Meanwhile, medical schools and clerkships should offer additional resources to students particularly vulnerable to stressors, including females and those with personal pandemic impacts.
| S-EPMC9353278 | biostudies-literature
Project description:BackgroundUndergraduate medical education was severely impacted by the COVID-19 pandemic. As traditional clinical rotations were suspended, medical students quickly began alternative, novel educational experiences. Third-year medical students at an academic medical center were given the opportunity to join inpatient eConsult teams within the department of medicine. This study describes the development and implementation of this program as well as the experiences of student and faculty participants.MethodsStudent eConsult participation was rapidly developed and implemented within medical subspecialty teams in either infectious diseases (ID) or nephrology. Twelve third-year medical students and 15 subspecialty attendings participated in this program during an eight-week period from April 6 through May 29, 2020. Breadth of student clinical experience was assessed via review of clinical documentation and surveys. Participating students and attending physicians completed surveys to reflect upon their impressions of the program. Surveys were returned by nine students and eight faculty members. Survey responses were summarized with descriptive statistics.ResultsOver an eight-week period, student consultants wrote 126 notes on 100 patients; 74 of these patients (74%) were hospitalized with COVID-19. Student experiences were largely positive with most strongly agreeing that attendings promoted interactive and engaged learning (N = 8 of 8, 100%), that the experience helped to expand their knowledge about consultant roles (N = 6, 75%), and that they would participate in a remote eConsult program again if given the opportunity (N = 6, 75%). Faculty also were largely positive about the experience with most agreeing or strongly agreeing with the importance of teaching medical students about telehealth (N = 7 of 8, 88%) and eConsults (N = 6, 75%). In narrative responses, students and faculty agreed that teaching was a strength of the program whereas lack of in-person contact was a challenge.ConclusionsRapid development of an inpatient eConsult-based educational experience for third-year medical students was feasible and successful. Student-consultants saw a range of pathology including COVID-19 and related complications. Students were satisfied with the program. They were able to develop a strong relationship with attendings while learning about the role of a consultant. Faculty agreed with the importance of teaching students about telehealth and eConsults specifically.
| S-EPMC7897886 | biostudies-literature
Project description:BackgroundAn innovative medical student elective combined student-directed, faculty-supported online learning with COVID-19 response field placements. This study evaluated students' experience in the course, the curriculum content and format, and its short-term impact on students' knowledge and attitudes around COVID-19.MethodsStudents responded to discussion board prompts throughout the course and submitted pre-/post-course reflections. Pre-/post-course questionnaires assessed pandemic knowledge and attitudes using 4-point Likert scales. Authors collected aggregate data on enrollment, discussion posts, field placements, and scholarly work resulting from course activities. After the elective, authors conducted a focus group with a convenience sample of 6 participants. Institutional elective evaluation data was included in analysis. Authors analyzed questionnaire data with summary statistics and paired t-tests comparing knowledge and attitudes before and after the elective. Reflection pieces, discussion posts, and focus group data were analyzed using content analysis with a phenomenological approach.ResultsTwenty-seven students enrolled. Each student posted an average of 2.4 original discussion posts and 3.1 responses. Mean knowledge score increased from 43.8 to 60.8% (p < 0.001) between pre- and post-course questionnaires. Knowledge self-assessment also increased (2.4 vs. 3.5 on Likert scale, p < 0.0001), and students reported increased engagement in the pandemic response (2.7 vs. 3.6, p < 0.0001). Students reported increased fluency in discussing the pandemic and increased appreciation for the field of public health. There was no difference in students' level of anxiety about the pandemic after course participation (3.0 vs. 3.1, p = 0.53). Twelve students (44.4%) completed the institutional evaluation. All rated the course "very good" or "excellent." Students favorably reviewed the field placements, suggested readings, self-directed research, and learning from peers. They suggested more clearly defined expectations and improved balance between volunteer and educational hours.ConclusionsThe elective was well-received by students, achieved stated objectives, and garnered public attention. Course leadership should monitor students' time commitment closely in service-learning settings to ensure appropriate balance of service and education. Student engagement in a disaster response is insufficient to address anxiety related to the disaster; future course iterations should include a focus on self-care during times of crisis. This educational innovation could serve as a model for medical schools globally.
| S-EPMC8003893 | biostudies-literature
Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has boosted medical students' vulnerability to various problems. Given the stressful nature of medical disciplines, considerable attention must be paid to student support systems during pandemics. This study aimed to review the current literature regarding medical student support systems systematically.MethodsWe performed a systematic review of six databases and grey literature sources in addition to a hand search in the references of the articles on April 5, 2021. We included all studies about support for undergraduate medical students delivered in response to the COVID-19 pandemic. In conducting this review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsA total of 3646 articles were retrieved from the databases, and 16 additional papers were extracted from other sources. After removing duplicates, we screened 2434 titles and abstracts according to our criteria. Among them, 32 full-text articles were assessed for eligibility. Ultimately, 10 studies were included for review. We identified two major themes: (a) academic support and (b) mental health support. All of the included studies utilized online methods whether for transitioning from previous support systems or developing novel approaches. Students and faculty members seemed to be receptive to these new systems. Despite indicating outstanding program outcomes, most studies merely described the positive effects of the program rather than providing a precise evaluation.ConclusionThere are several methods of supporting medical students who are experiencing unprecedented changes in their educational trajectory. Due to substantial differences in undergraduate medical education in different regions of the world, cultural and contextual-oriented support is indispensable for developing a safe learning environment. Future research should investigate the question of the extent to which online support can supersede in-person strategies.
| S-EPMC8218568 | biostudies-literature
Project description:BackgroundDuring the Covid-19 pandemic medical students were offered paid roles as medical student healthcare assistants. Anecdotal reports suggested that students found this experience rich for learning. Previous studies have explored alternative models of student service, however this defined medical student support role is novel.MethodsIndividual semi-structured interviews were recorded with 20 medical students at a UK medical school exploring their experiences of placement learning and experiences of working as healthcare assistants. Responses were analysed qualitatively using a framework approach. The framework was developed into a model describing key findings and their relationships.ResultsInterviews yielded data that broadly covered aspects of (1) Medical students' experiences of clinical placement learning (2) Medical students' experiences of working as medical student healthcare assistants (3) Learning resulting from working as a healthcare assistant (4) Hierarchies and professional barriers in the clinical environment (5) Influences on professional identity. Participants described barriers and facilitators of clinical learning and how assuming a healthcare assistant role impacted on learning and socialisation within the multidisciplinary team. Students became increasingly socialised within the healthcare team, contributing directly to patient care; the resulting social capital opened new opportunities for learning, team working and enhanced students' interprofessional identity. Students described the impact of these experiences on their aspirations for their future practice.ConclusionsChanges to work patterns in healthcare and delivery models of medical education have eroded opportunities for students to contribute to healthcare delivery and be embedded within a team. This is impacting negatively on student learning and socialisation and we suggest that medical curricula have much to learn from nursing and allied health professional training. Longitudinal embedment with a multidisciplinary team, where students have a defined role and work directly with patients may not only add value to clinical service, but also overcome current barriers to effective placement learning and interprofessional identity formation for medical students.
| S-EPMC8131173 | biostudies-literature
Project description:BackgroundCOVID-19 has disrupted medical education in the United Kingdom (UK). The pandemic may result in a long-term disproportionate negative impact to students applying to Medical School from a low-socioeconomic background. In addition, the upsurge in Medical School applications increases the likelihood of stricter University entry criteria over the coming years. There is no current research to determine how widening participation of Medicine to students from low-socioeconomic backgrounds can be improved virtually. The aim of this study is to establish the impact of COVID-19 on students enrolled in UK widening access schemes and the role of virtual student led initiatives in widening participation.MethodsA voluntary online survey was distributed to UK Sixth Form students (N = 31) enrolled in a widening access scheme who attended Sheffield Neuroscience Society International Virtual Conference in February 2021. The event was free to attend. The five-domain survey consisted of questions determining demographics, career aspirations, impact of COVID-19, academic skillsets and an educational manipulation check.ResultsThere were 30 pre-conference and 26 post-conference responses. 76.7 % had work experience cancelled due to COVID-19. A total of 36.7 % of participants reported participating in virtual work experience. 'Observe GP' and 'Medic Mentor' were each specified as attended virtual opportunities in 20 % of answers. Post conference, students felt significantly more confident in applying to Medical School (p = 0.008) and more prepared to undertake a presentation (p = 0.002). Educational manipulation check scores increased significantly (p = 0.003). 100 % of students felt inspired to do further CV building activities.ConclusionsCOVID-19 has negatively impacted pupils enrolled in UK Medical School widening access schemes. Virtual student led initiatives can instill confidence in delegates from low socio-economic backgrounds, increase their career knowledge and inspire them to take part in further CV building exercises. Both Medical Schools and medical students play a key role in widening participation. This study recommends Medical Schools promote access to virtual events, urge private and state schools to declare offered opportunities and act mindfully when determining student's academic potential in the context of their socioeconomic and/or educational background.
| S-EPMC8203309 | biostudies-literature
Project description:BackgroundThe coronavirus pandemic has exerted significant impacts on primary care, causing rapid digital transformation, exacerbating social isolation, and disrupting medical student and General Practice [GP] trainee education. Here we report on a medical student telephone initiative set-up by a final year GP trainee (the equivalent of a family medicine resident), which aimed to support patients at high risk and vulnerable to the Coronavirus Disease of 2019 [Covid-19]. In addition, it was hoped the project would mitigate a digital divide, enable proactive anticipatory planning, and provide an active learning environment to compensate for the pandemic's impact on medical education.MethodsThirty-three medical students conducted daily telephone conversations with high risk and vulnerable patients as specified by the initial NHSE published lists. They confirmed public health messages, offered details for voluntary support groups, established need for medication delivery, explored levels of digital connectivity, and prompted discussions around end-of-life choices. Students had access to online reflective resources and daily remote debriefing sessions with the GP trainee. A convergent mixed-methods evaluation was subsequently undertaken, using quantitative process and descriptive data and individual qualitative interviews were conducted according to a maximal variation sampling strategy with students, General Practitioners [GPs], and the GP trainee. Inductive thematic analysis was then applied with cross-validation, respondent validation, and rich evidential illustration aiding integrity.ResultsNinety-seven 'high risk' and 781 'vulnerable' calls were made. Individuals were generally aware of public heath information, but some struggled to interpret and apply it within their own lives. Therefore respondents felt students provided additional practical and psychological benefits, particularly with regard to strengthening the links with the community voluntary groups. The project was widely liked by students who reported high levels of skill development and widened awareness, particularly valuing the active learning environment and reflective feedback sessions.ConclusionThis study demonstrates utilization of medical students as wider assets within the primary health care team, with an initiative that enables support for vulnerable patients whilst promoting active medical education. Ongoing integration of students within 'normal' primary health care roles, such as chronic disease or mental health reviews, could provide similar opportunities for supported active and reflective learning.
| S-EPMC7578590 | biostudies-literature
Project description:The COVID-19 pandemic caused a large strain on the US medical system, with shortage of medical personnel being a key issue. The role of medical school students during a pandemic is not well established. Understanding the perspectives of medical students with regard to their role is essential in determining how to facilitate the use of their skills in combating the pandemic. To evaluate medical student perspectives on the COVID-19 pandemic, an anonymous online survey was distributed to medical students, primarily in the Northeastern United States. In the sample of 232 students, there were significant differences between students in different class years when assessing moral obligations to assist with the COVID-19 pandemic (p = 0.002). A higher percentage of first and second year medical students (pre-clinical training, around 48%) felt that healthcare students are morally obligated to assist as compared to third and fourth year students (clinical training, 30.43% of third years and 23.19% of fourth years). In all class years, the majority said they would regret their decision if they had chosen not to study medicine (62.32% to 79.31%) and most students did not feel their motivation to become a physician had been decreased (84.78% to 87.50%). Though the study was limited because the majority of subjects were from New York, the results provide insight into medical students' attitudes about the COVID-19 pandemic and can be used in the planning of how best to utilize medical students in this and in future situations.Supplementary informationThe online version contains supplementary material available at 10.1007/s40670-021-01374-z.
| S-EPMC8425853 | biostudies-literature
Project description:The Transition to Wellness Program is an occupational therapy (OT) based program that was developed in response to the COVID-19 pandemic. For OT students, fieldwork is a required element of their training. In March 2020, these were being halted due to lockdowns and the risk to students in healthcare settings. Facing significant delays to graduation for 60 students, including some unable to be placed into healthcare settings due to underlying conditions, the development of a telehealth program was conceived to address this, while still meeting the accreditation clinical/health/wellness standards for OT fieldwork. A group of students, with faculty oversight, developed the theoretical basis, tools, policies and procedures for the program. An incremental launch allowed testing and refinement of the program to meet the educational needs of the students and the wellness needs of the clients. At its launch, the program supported 10 of that cohorts' 60 students to continue to meet the required academic standards and progress through their fieldwork towards graduation. Each student got to experience the "telehealth" model in providing OT wellness interventions to individuals in the local community. Future work will focus on continuing to broaden the reach of the program and measure the outcomes.
| S-EPMC9343972 | biostudies-literature
Project description:Background and significanceWhen hospitals are subject to prolonged surges in patients, such as during the coronavirus disease 2019 (COVID-19) pandemic, additional clinicians may be needed to care for the rapid increase of acutely ill patients. How might we quickly prepare a large number of ambulatory-based clinicians to care for hospitalized patients using the inpatient workflow of the electronic health record (EHR)?ObjectivesThe aim of the study is to create a successful training intervention which prepares ambulatory-based clinicians as they transition to inpatient services.MethodsWe created a training guide with embedded videos that describes the workflow of an inpatient clinician. We delivered this intervention via an e-mail hyperlink, a static hyperlink inside of the EHR, and an on-demand hyperlink within the EHR.ResultsIn anticipation of the first peak of inpatients with COVID-19 in April 2020, the training manual was accessed 261 times by 167 unique users as clinicians anticipated being called into service. As our institution has not yet needed to deploy ambulatory-based clinicians for inpatient service, usage data of the training document is still pending.ConclusionWe intend that our novel implementation of a multimedia, highly accessible onboarding document with access from points inside and outside of the EHR will improve clinician performance and serve as a helpful example to other organizations during the COVID-19 pandemic and beyond.
| S-EPMC7710441 | biostudies-literature