The University of Alabama at Birmingham (UAB) is an urban academic medical center located in Birmingham, AL. Patients across the region depend on UAB for a wide range of primary and specialty care services. Thus, in mid-March when the COVID-19 pandemic extended to Alabama, the UAB Health System recognized the need to create a high volume testing center to identify people with COVID-19. Simultaneously, UAB School of Medicine made the decision to remove medical students from clinical duties, and students were experiencing significant disappointment and frustration at their “non-essential” status.
The Call Center
In response to the need for COVID-19 testing within the community, the UAB Health System created a system for drive-thru testing, relying on appointments made over the phone using an evidence-based screening algorithm. A team of nurses was hired to staff the phone lines alongside a host of information technology specialists, nursing administrators, and quality improvement officers all working together in an off-campus administrative facility. There was concern for very high call volumes, so when the SOM offered assistance from eager third and fourth year medical students, the offer was readily accepted. The SOM’s Office of Service (OSL) Learning ensured the school’s criteria for student safety were met, including the following: all opportunities must be strictly voluntary, within the scope of training, well-supervised, allow for appropriate physical distancing, and not patient-facing. The OSL sent out a call for volunteers, and eighty-six students immediately volunteered. Students participated in virtual training on Zoom alongside many other interprofessional team members, totaling greater than two hundred employees. This online training focused on navigating the screening and scheduling interfaces.
Two days after training, the call center went live, and student volunteers began working the phone lines in 4-hour shifts. The call center was located a few miles away from the testing site in an administrative building. Upon arrival volunteers were led to cubicles, spaced at least six feet away from one another, and were equipped with new headsets, telephones, and double-screen monitors. Nursing administrators and IT specialists floated between cubicles to answer questions and provide updates on appointments. Since this project developed rapidly to manage an active crisis, guidelines for screening, scheduling, and counseling were also evolving. Throughout the process, the OSL was in constant communication with students, and appointed two student coordinators. The coordinators sent out a text message to each group of volunteers every day to serve as a point of contact for feedback/questions, and to offer reminders about physical distancing and safety. The OSL also established a Google Drive folder that was accessible to all volunteers and included logistical information, updated CDC recommendations, and important feedback from previous volunteers.
Working at a call center, at least in this capacity, was a new experience for most everyone there, and thus being flexible was a necessity. Although the call volume was high during the first few days of the call center, subsequent days were more predictable and required less staff than previously thought. Furthermore, as clinics closed and elective surgeries were cancelled, many nurses were being furloughed. In an attempt to find alternative roles for these nurses, the health system asked them to staff the call center in place of medical student volunteers. While the feedback from the call center staff for medical students was overwhelmingly positive, the schedule was changed to include only nursing staff rather than students. Currently, call volumes for this testing center site have remained manageable, thus medical students are no longer working at the call center. Multiple students never had the opportunity to work at the call center at all.
To understand how to improve this interprofessional service-learning initiative, we solicited volunteer feedback with the hope that this information can help other institutions create a robust form of this project for their own health care system. Twenty of twenty-two volunteers replied to a series of questions directed towards understanding the educational value of this experience, preparedness for their role at the call center, and suggestions to improve the overall experience.
Regarding the educational piece of this initiative, we received overwhelmingly positive feedback. Students particularly commented on how this service-learning opportunity seemed relevant for future career preparation, as it allowed counseling opportunities and encouraged civic engagement. Volunteers noted how this was their first exposure to telemedicine and how telemedicine will likely expand and become part of their medical practice in the future. In this role, students triaged patients based on history alone without the comfort of a physical exam, which sharpened their ability to gather relevant information and then use an algorithm to solve a clinical problem. This is a skill they will certainly need and hone throughout their careers. Students learned about the process of disaster response within an urban academic medical center as well as learning about our local infrastructure in Birmingham. This experience highlights a unique opportunity to counsel patients with intense anxiety or frustration at not qualifying for testing. Volunteers became more comfortable delivering bad news throughout the call shift as they picked up on undertones of frustration, worry, and confusion of the patient on the other line. Students became more well- versed at addressing each patients’ unique concerns. Volunteers also enjoyed working alongside experienced nurses as they were extremely welcoming and created a comfortable learning environment for them. Lastly, third year medical students found this was an ideal opportunity to safely contribute to the health of their community since they were no longer allowed to perform clinical duties and have in-person contact with patient.
Furthermore, when asked about their comfort level in addressing caller questions and concerns, respondents did not feel like they were asked to do anything out of scope. Having a short document that was frequently updated based on feedback and call center policy updates helped them acclimate more quickly to the fast-paced environment. We believe that, in addition to the welcoming staff and mutual goal to help during a crisis, having two student coordinators to relay information from the call center and field questions helped volunteer comfort level.
To improve the call center volunteer framework (if students are needed in the future), we hope to streamline preparation materials and have an onsite worker to direct medical student questions to, in addition to the two student coordinators. Instead of a Zoom training session, we would send out a PowerPoint to first-time volunteers and continue with a short onsite training orientation for the first shift. The PowerPoint should include how to log into and operate the screening software, a general walk-through of the screening process so you can explain it accurately to callers, and a short script on how to counsel patients based on whether or not they will be screened. Doing this will make training more efficient and not exclude anyone who would like to volunteer but was unable to make the initial zoom call. While the environment was very friendly and accommodating, having a designated worker on site to answer volunteer questions would help with any concerns that might arise during their shift. Lastly, while a remote volunteer option was not feasible during our time, we hope that remote volunteering will be considered for our call center or similar service-learning projects in the future so more student- volunteers can participate safely.
Overall, students enjoyed their time volunteering and felt the role was appropriate. Students felt it was an excellent way to champion service-learning and community activism while supporting the broader needs of the health system.
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