When the state of Florida ordered all public universities to transition to distance learning in March, educators at the Herbert Wertheim College of Medicine had to get creative.
Normally, medical students practice clinical skills on patient simulators and mannequins or through personal encounters with standardized patients (actors playing the role of a patient). But these are not normal times. Due to the COVID-19 pandemic, the college’s simulation center had to be closed, and hospitals and clinics where students get to shadow physicians canceled student rotations.
“The transition to remote learning was abrupt,” said Dr. Vivian Obeso, associate dean for curriculum and medical education. “But our course directors and faculty rose to the challenge. They embraced technology and developed innovative teaching sessions and clinical courses. I am so proud of our team.”
Zoom technology and web-based learning tools like Acquifer and WiseMD became critical in teaching students in virtual classrooms and discussion groups. To preserve active learning, weekly question and answer sessions via Zoom, and frequent remote quizzes on the Canvas Learning Management Platform kept students engaged and on track.
Teaching clinical skills remotely presented a special challenge. “We had to develop a new telehealth curriculum,” said Dr. Maria Stevens, director of clinical skills. “We created a virtual OSCE.”
OSCE stands for Objective Structured Clinical Examination. During an OSCE, students go through a series of stations in which they encounter standardized patients who present with a medical problem. Students are evaluated on communication skills, history taking, patient care, clinical reasoning and professionalism. It is a hands-on experience, or at least it was, before COVID-19.
Instead, students created videos to demonstrate their clinical skills, and virtual Meet the Patient panels allowed them to interview standardized patients (SP) online. To tie-in to the current crisis, the SPs played the role of a patient experiencing cough and other symptoms of possible COVID-19 exposure. Later this month, Stevens will present HWCOM’s innovative virtual OSCE curriculum at a webinar for DOCS, a national organization for clinical skills course directors.
The Green Family Foundation NeighborhoodHELP program also introduced telemedicine into its curriculum, allowing students to virtually check in on their assigned households. Students in the Community Engaged Physician course completed 56 tele-household visits in the first week of June. During these calls, students provided information about the virus, assessed household needs and connected them with community resources.
For all the challenges that the COVID-19 crisis presented medical educators, it also has provided them what may be a once-in-a-lifetime opportunity to teach students about pandemics during a pandemic.
HWCOM’S COVID-19 Project, a group-based simulation exercise, assigned groups of 4 to 5 students to choose a clinical scenario: either an emergency department or an internal medicine private practice. The groups had to create a PowerPoint presentation describing the patient/staff safety protocols, workflow, patient flow, testing protocols and reporting measures they would put in place if they assumed the role of lead physician or medical director during the Covid-19 pandemic.
“We saw this as a great teaching moment, and we are very proud that the Association of American Medical Colleges featured our COVID-19 Project on its website,” said Sarah Stumbar, assistant dean for clinical education.
HWCOM developed other courses specifically designed to address the pandemic. The Ethics During Pandemics course probed ethical considerations in responses to the pandemic, including the restriction of individual freedoms in the name of public health.
In the Narrative Medicine in the Time of COVID-19 course, an existentialist literary classic helped frame the ongoing health crisis. Students read Albert Camus’ The Plague and discussed how the book’s major themes applied to the current pandemic. At the end of the book, the plague eventually abates, quarantines are lifted, and life can begin to get back to normal.
Similarly, HWCOM faculty and staff are now working on plans to gradually reopen and safely reintroduce students to the classroom and clinical rotations.