Transitions to Residency courses have been increasing in popularity and scope for several years. Many of these courses are heavily hands on as they endeavor to prepare graduating fourth year students for internship. The Transitions to Residency capstone at GW is a 4-week example of a multi-specialty, multimodality transitions course which requires in-person attendance for all graduating students. Our overall course structure contains undifferentiated internship readiness lectures and simulation modules and synchronous specialty specific curricula and sessions delivered via various modalities. Modalities used include large and small group lectures, field trips, standardized patient interviews and physical examinations, computerized simulations, and general and specialty specific procedural instruction. The course does not introduce these skills in a novel way, rather, the course is the underline of sorts to a diverse four- year experience at GW which introduces these concepts over the course of the medical school curricula. Professionalism and professional identity development are an emphasis throughout our Transitions to Residency Course.
The Washington, DC social distancing and stay at home orders for the COVID-19 pandemic were announced in the middle of our course. Over the course of a weekend, we adapted the remaining curriculum in several innovative ways using a stepwise approach which both evaluated and used existing online resources and used novel ways to adapt our current content. We delivered live content via WebEx or Zoom platforms, utilizing the breakout functions for smaller subgroup discussion. To ensure transfer, students were required to submit a summary of clinical learning pearls by email by the close of day for many of the sessions. We have included a description of a representative sample of modifications made to our sessions.
Examples of General Instruction Modifications
- US Guided IV Placement Final Exam- Instead of testing students on their ability to perform this skill correctly, students watched an online video prepared by classmates and were tested on their ability to identify subtle errors.
- Informed Consent modules – Students completed an online module and faculty facilitated small group while playing the role of the patient. Students took turns obtaining consent for a blood transfusion emphasizing common questions and ethical dilemmas. Students were evaluated on their communication skills and knowledge of the basic tenants of obtaining informed consent.
- Large Group lectures – These were delivered with WebEx with attendance taken by QR codes. QR codes were embedded in the lectures and students were able to scan the codes from their computer screens at home using their cell phones.
Examples of Specialty Specific Modifications
- Surgery – seamlessly transferred its popular “On-Call” Mock paging exercise.
- Emergency Medicine – Adapted its trauma simulation sessions to a “Chose your Own Adventure” Online format
- Family Medicine – Delivered content on caring for mother and baby post-partum. Instead of practicing post-partum contraceptive counseling in person, students participated in an online lecture and were required to submit a 3-5-minute video of themselves counseling a patient.
- Family Medicine – Students practiced a systematic approach to evaluating evidenced based guidelines in Zoom Breakout groups using the process the AFP journal uses to evaluate medical guidelines with the assistant editor of the AFP journal.
- Anesthesia - Students reviewed online content for placing arterial lines available from the NEJM and met via WebEx with the faculty to discuss their observations.
- Internal Medicine Order Sets – In groups of 2-3, students interviewed standardized patients virtually and asked for physical exam findings. They submitted proposed order sets based on the patient presentations. The students were then randomized to larger debrief groups with Faculty members via WebEx to review their learning.
- Pediatrics – Traditionally Pediatric and Family Medicine students have a field day excursion of deliverables to examine the social determinants of health that influence childhood poverty. This curriculum is forthcoming on MedEd portal.
- OB – Presented a case based GYN emergencies discussion and Olympics. Students actively engaged using the chat function to determine how they would manage the patient.
There were many other examples but in all the faculty was largely able to successfully modify the remaining two weeks of the course to an online format. Standard evaluations are still being calculated but many students voiced positive feedback for the course modifications in the midst of a very difficult time for them as fourth year medical students.
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