by Alexandra Brown.
The world is looking a bit different these days. In response to the global pandemic, people are encouraged to stay home, self-isolate and shelter-in-place. Most non-essential businesses have closed and schools have transitioned to an online platform. Recent reports from the CDC encourage people to stay home whenever possible and to wear cloth face coverings when outings are absolutely necessary, such as when buying groceries(1). This is not meant to be a political or scientific piece; rather, the purpose is to shed light on how a medical school is adapting in order to continue training future healthcare professionals. All healthcare professionals are essential to the health and well-being of our society and they continue to provide the incredible, selfless role of serving others. Now, more than ever, healthcare workers are on the front lines. They are putting themselves in harm’s way to care for patients and in order to advocate, educate, and protect others.
The clinic has also largely closed, which was a very difficult decision, but one that was made in the best interest of patient and healthcare team safety.
Temple University School of Podiatric Medicine has made significant changes to mitigate the risk of exposure for both students and patients. Students were encouraged to settle wherever they felt safest during this time, meaning many students traveled home to be with family. The clinic has also largely closed, which was a very difficult decision, but one that was made in the best interest of patient and healthcare team safety. However, clinicians are still seeing patients with urgent needs, such as wound care and post-op appointments, while adhering to proper protocol of screening and wearing personal protective equipment. Additionally, some clinicians have incorporated telemedicine in order to better serve the needs of patients during these challenging times. Didactically, the faculty at Temple University School of Podiatric Medicine (TUSPM) has also invested countless hours to essentially generate a new system for providing pre-clinical education and examinations to students, in addition to incorporating daily online academics to students in clinical years (third and fourth-year students).
Going Virtual
As a second-year student, our spring semester was originally scheduled to include hands-on training such as Operating Room Protocol, Surgical Skills, Patient Simulation Center, and time in clinic through our Fundamentals of Podiatric Practice course. Since these places and buildings are all closed for the foreseeable future, changes in the curriculum were necessary. Recognizing that workshops and hands-on clinical training must be postponed until it is safe for students to return to campus, the faculty adjusted the curriculum. The administration was able to exchange some courses that were originally scheduled for the fall that are more easily taught online to be able to fit the labs and workshop-heavy courses later on in our training. In an effort to provide interactive lectures to students remotely, professors received a crash-course in a platform for video and audio conferencing. Students have been able to listen to the professors and ask questions in real-time. Very few classes and exams were delayed to accommodate the transition to online learning. In my experience, maintaining the class schedule and attending live (virtual) classes has helped students stay as engaged as possible.
One of the most inspiring classes at this time has been our Fundamentals of Podiatric Practice course, led by Dr. Khurram Khan and Ms. Raquel Perez. Ms. Perez serves as a clinical instructor for the medical department at TUSPM. She is the Director of the Standardized Patient program, and is therefore heavily involved in both pre-clinical and clinical education for students. Ms. Perez leads the team in the patient simulation center, trains the patient instructors and standardized patients, and ultimately provides an experience for students to develop clinical skills in a safe and controlled environment. The emphasis of first-year is to focus on the general physical exam and podiatric-specific exam. During second-year, the course focuses on simulating the complete patient interview. She also contributes to the preparation of third-year students for Part II boards, the Clinical Skills Patient Encounter (CSPE) component. Fortunately for third-year students, the training for the CSPE exam had concluded prior to the COVID-19 pandemic.
How do we take exams?
Ms. Perez has impressively and quickly adapted to online education, allowing first and second-year students to continue their respective patient simulation experiences remotely. The first-year students were sent home towards the end of their patient simulation experiences, so Ms. Perez taught the final few sessions online. For the final exam, students prepared video submissions of complete physical exams on him or herself to demonstrate proficiency. The second-year students, however, had not begun the class yet. As the focus of patient simulations during second-year is to communicate and build rapport with patients, telemedicine presented an opportunity to focus on “perfecting medical practice”. Ms. Perez aptly described this skill as “being able to communicate with precise and direct language without being impersonal or insensitive” which ensures that the patient receives the information as intended by the care provider. This ultimately allows physicians and patients to collaborate in their plan of care more effectively.
Over video chat with standardized patients, a student doctor’s tone, facial expressions, body language, and a tactful interview style…
During our first online lecture, Ms. Perez provided the fascinating history of telehealth and explained how it has been incorporated by other modalities already; with psychiatry patients, elderly patients, and those with limited mobility. The limitation of this practice is the inability to perform the physical exam, and as such, certain workshops have been delayed until classes resume on campus. That being said, Ms. Perez has been able to succeed in the face of challenges by encouraging students to hone their interpersonal skills. Over video chat with standardized patients, a student doctor’s tone, facial expressions, body language, and a tactful interview style are crucial for an optimal patient interaction. Ms. Perez uses the term “code-switching” to describe the ability for care providers to switch between clinical and layman’s terms to communicate with patients at a level that will ensure the patients’ understanding. All of these skills can be practiced with video conferencing.
Our first virtual standardized patient interviews were completed earlier this week and it was a successful experience. Students dressed professionally and were engaged in interviewing standardized patients via video conferencing. It was a good learning experience, allowing us to practice interviewing and develop trusting relationships with patients. As we continue our learning online, Ms. Perez encourages students to embrace the social science aspect of healthcare. These changes require students and faculty to be progressive and open-minded, and it presents a chance for students to learn a novel skill-set not previously included in the curriculum.
Final Toughts
Although this is not what we expected for our pre-clinical education, we are fortunate to have professors and instructors who are willing to learn new mediums and adapt to continue providing high-quality medical education. This is not a setback, but rather an opportunity to learn a new means of providing healthcare. Of course, the goal is that we may never or very rarely ever need to use telemedicine, but our class will be trained to do so if necessary. I am grateful for the opportunity to continue on this path and eventually serve patients, as the incredible healthcare workers are doing right now. Thank you, health heroes.
by Alexandra Brown.
School: Temple University School of Podiatric Medicine
Thank you to Ms. Raquel Perez for her contributions to this article.
Resources
- “Recommendation Regarding the Use of Cloth Face Coverings.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Apr. 2020, www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html
COVID-19 and Changes in Pre-Clinical Curricula
Topic Review, Student Life, History
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