The COVID-19 pandemic has significantly impacted ambulatory care. In a report produced by the Commonwealth Fund it is estimated that at the start of April 2020, the number of in-person visits to outpatient practices declined by more than 50% from baseline. The primary reason for this abrupt fall stems from common-sense actions taken -- such as deferring elective visits and restricting travel and non-essential services -- to mitigate transmission of the virus to both patients and health care workers. Many practices are converting in-person visits to telemedicine visits in response to this new service gap.
While transitioning to virtual care is both necessary and practical for several reasons, the actual practice of fundamentally shifting platforms of care has been marred by the expected challenges associated with integrating new technologies into standard outpatient visits. Presently, telehealth visits have compensated for merely 13% of the decline in ambulatory visits. Recognizing the potential of telemedicine to significantly offset the drop in in-person visits, the students at Rutgers - Robert Wood Johnson Medical School collaborated with clinic administrators and medical staff to design and implement a workflow where student volunteers assist patients in navigating the newly implemented telehealth system. Currently, a team of over 170 students from the M1, M3, and M4 classes is trained to initiate virtual patient encounters, document clinically relevant information (i.e. chief complaint, succinct history of present illness, medication reconciliation, vitals, etc.), and room patients in providers’ telehealth rooms. In parallel with a growing student taskforce, a growing number of providers from the departments of internal medicine, pediatrics, family medicine, neurology and obstetrics & gynecology are partnering with students. Patient participation in telemedicine visits notably increases when students are involved.
Since the launch of this initiative, students have participated in over 1000 patient telemedicine visits. While the efforts are completely voluntary, students are given the option to obtain credit for a newly made telemedicine elective based on the number of hours contributed on a weekly basis. As direct patient-contact clinical experiences remain suspended for the foreseeable future, there is great hope that this telemedicine experience can be adapted and integrated into clerkship students’ core rotations in the near future.
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