Feinberg School of Medicine COVID Response: M3 Volunteer Efforts

Here we describe the efforts taken by M3 students at Northwestern University’s Feinberg School of Medicine (FSM) in response to the COVID-19 pandemic. We detail specific projects developed by students and faculty that allow us to contribute to clinical teams remotely, as well as the successful implementation of these into practice. We are highlighting 3 initiatives that target the following settings: outpatient care, inpatient care, and our medical student community. 

• Telemedicine at Student Continuity Clinics: Telemedicine enables medical students to help "flatten the curve" by utilizing technology to evaluate high-risk patients without physical contact. We utilize telemedicine in three ways: check-in calls, formal e-visits, and monitoring patients with presumed or diagnosed COVID. For check-in calls, attendings in Education-Centered Medical Homes (ECMH), our outpatient student continuity clinics, created lists of vulnerable patients with risk factors that elevate their probability for developing more severe COVID-19 presentations. Medical students call these patients to assess for COVID symptoms, screen for suicidal ideation and food insecurity, and address any other concerns. Students connect patients with resources, such as nearby food banks, and refer patients to social workers who follow up with additional assistance. Students also utilize an algorithm to triage patients who screen positive for COVID symptoms. Patients with non-COVID related concerns (e.g. medication refills, chronic management) are scheduled for longer e-visits. Medical students review the patients’ charts, call patients, elicit concerns, and conference with attendings to discuss the results before relaying plans to patients. Students then pend orders and write billable notes. Furthermore, students use telemedicine to monitor patients who test positive for COVID or those who have respiratory symptoms without a need for hospitalization. These patients receive a daily message through our institution’s online portal asking questions about their health status (e.g. cough, fever, shortness of breath). Medical students follow up daily with these patients if they continue to report symptoms or do not respond to the online messages. If the patient reports severe respiratory symptoms, they are referred to the Emergency Department. 
• Virtual Scribe Program: FSM medical students have also been able to remotely assist inpatient hospital teams. Third-year medical students are adept at writing discharge summaries from learned experience during clerkships. While discharge summaries are a necessary part of documenting patient care, writing them is an additional clerical duty that can remove residents and attendings from the immediate needs of patients on the floor. Using a guide developed by students at the University of California San Diego, third-year students adapted the protocol to connect experienced students to hospital medicine teams. Students volunteer to follow five inpatients for assigned two-week blocks, during which each spends 1-2 hours daily reviewing patients with their assigned teams and updating discharge paperwork virtually through the EMR. Students utilize a shared template to format notes and ensure that all documentation remains consistent with attending or resident preferences. This program allows clinical students to help inpatient teams from the safety of home and enables careful and thoughtful handoffs. 
• MSGratitude: MSGratitude is a project originally developed at University of Colorado SOM which focuses on medical student wellness during the COVID-19 pandemic. Medical students are invited to share pieces of gratitude, reflection, and art each week which are then published once a week to promote community and wellness. This is a grassroots movement which now includes about 15 participating medical schools across the country. Our hope is that by feeling well and staying connected, students will be more inclined to take action. Twitter: @GratitudeMS