This article is part of a series in The Hospital Leader written by members of the Division of Hospital Medicine at Dell Medical School at The University of Texas in Austin, exploring lessons learned from the coronavirus pandemic and outlining an approach for creating COVID-19 Centers of Excellence.
The COVID-19 pandemic shook up the medical education world at all levels. Medical schools, residency programs and academic institutions throughout the nation found themselves asking fundamental questions about the role, safety and needs of their learners.
In particular, at the undergraduate medical education (UME) level, the pandemic brought with it a roller coaster ride for medical students throughout the country. In March 2020, as the pandemic first hit the US, most medical schools—including Dell Medical School (DMS)—pulled students out of their clinical rotations. It was a brief hiatus as we all struggled to understand and handle what was, in essence, a tsunami that overwhelmed our health care systems. The biggest challenge came with the restructuring of curricula for students who were in the middle of their clinical rotations. Didactics were rapidly transitioned to virtual formats. Online modules were developed and adapted to deliver interactive teaching sessions.
But we were left with the question of how to engage students in patient care while outside the clinical setting.
As we considered opportunities to maintain student engagement in a virtual patient care model, we went back to our medical school’s mission. At DMS, in addition to the traditional core competencies, we highlight competencies that focus on student leadership. This includes leading innovation in health care systems, such as applying strategic perspectives to problem-solving related to community health. As part of their leadership development curriculum, and in an effort to develop “systems-ready physicians,” our students learn about health systems sciences in their first year of medical school and subsequently put what they’ve learned into practice in the core clerkships and other clinical rotations.
After students were pulled out of the clinical setting, we created several new remotely-administered patient care courses and electives that align with our school’s mission and core competencies. These were not only educational, but also allowed students to lead and to serve our local community. These included, for example, telemedicine electives, e-consult electives and a novel “Transitions of Care (TOC) Elective.”
Ambulatory care was made safer by transitioning to the virtual space. We recruited faculty who were now practicing electronic consultation and telemedicine to allow students to participate in these emerging care modalities—not only because there was an opportunity to engage in this work during the pandemic, but also because we saw that skill and experience using technology to meet patients “where they are” will be part of a future healthcare delivery system that better serves society.
The COVID-19 pandemic exacerbated known challenges and gaps in our healthcare system, one of which is coordinating transitions of care. Care transitions are known to be an especially treacherous part of the patient care journey, frequently leading to errors and adverse outcomes if done ineffectively, and disproportionately impacting vulnerable patient populations. While transitions of care is a pivotal part of patient care, it is infrequently taught at the UME level, and when it is, this is typically relegated to the classroom setting.
The new TOC Elective introduced during the COVID-19 pandemic includes three components, all delivered virtually:
- Participating in patient care, including conducting patient needs assessments;
- Participating in and leading critical conversations; and
- Supporting patient transitions of care, including coordinating multidisciplinary care, warm hand-offs and discharge planning.
Students were essentially virtual members of hospital-based COVID teams, connecting remotely with patients and coordinating care with in-hospital and post-discharge teams. They served as the “glue” that held things together as patients transitioned from one setting to another. For example, students coordinated care with primary care doctors, contacted family members to make sure they had testing available and helped them access food resources and gave daily medical updates with supervision from the team.
Students found this experience highly valuable, learning about the challenges of health communications, the complexity of navigating the healthcare system and the need for better transitions. One student noted that transitions of care is “…a big game of telephone that places unnecessary burden on patients. We as students can help to relieve that strain while learning the intricacies of the system and thinking of ways to improve it.” Not only did students find their TOC experiences to be eye-opening and informative, team members also found that the students added a lot of value to patient care and to teamwork. They noted that the students’ work was “incredibly helpful ” and that “…they’re really complementing the work needed for our COVID-19 patients in the hospital.”
As noted by Jamie Notter, “innovation is change that unlocks new value.” The challenges that the COVID-19 pandemic presented brought with them new opportunities for value-added medical education. Rather than excluding our students from clinical care entirely, we leaned in and looked for new opportunities to advance care and education in novel ways. The COVID-19 pandemic is teaching all of us that the practice of medicine will never be the same. We want our learners to be prepared for the future, and to see obstacles as opportunities—one of the key competencies we hope to foster in the next generation of physicians who are prepared to lead innovative change in health. The educational innovations prompted by the pandemic are examples of the creativity that disruption can create.
Yes! I admire and applaud this initiative! Thank you for your work!