Telemedicine latest tool in Jacobs School training

Medical students at the Jacobs School of Medicine and Biomedical Sciences are finding themselves at the forefront of a new type of medical training brought on by the COVID-19 pandemic.

During the first two weeks of January, third-year students taking the IDM 730 Core Topics “intersessions” course received training in telemedicine while practicing with standardized patients during sessions that were taught via videoconferencing.

The “Challenging Communication Scenarios” sessions were converted to telemedicine when all intersession classes became remote this year so students could vacation with family over the break and then quarantine for the two weeks of intersessions if needed.

“Students have been on clerkships for six months with no designated break in the middle of a pandemic. It’s been incredibly stressful, in addition to having their whole second year disrupted because of COVID-19,” says Daniel W. Sheehan, associate dean for medical curriculum and director of the course. “We wanted them to have two weeks with family and friends in order to recharge. We decided we were going to make these two weeks remote, and we made it happen.”

Staff made modifications so that the Margaret L. Wendt Foundation Clinical Competency Center (CCC) and the Behling Human Simulation Center (BHSC) — which are used for training with standardized patients — could be compatible with videoconferencing.

While in-person training is still preferred, participants are finding this is the next best thing.

“The staff here have just been amazing to make this happen and the faculty have embraced it because many of them are doing telehealth, and they see the importance of it,” says Sheehan, who is also a clinical professor of pediatrics and director of the Office of Accreditation and Quality Improvement. “This will be incorporated into the curriculum because telemedicine is here to stay in some capacity, as it can provide health care to both rural and urban patients with transportation challenges.”

“It is a new form of telemedicine. Everyone is delighted with how this is working out. It’s really amazing,” says Karen L. Zinnerstrom, administrative director of the CCC and BHSC. “You can see the delight on the faculty facilitators’ faces. They’re all thoroughly enjoying it. From a faculty perspective and from students, we haven’t heard any complaints.”

In the class, standardized patients (SPs) play various roles related to what they are dealing with — domestic violence, post-traumatic stress disorder or sickle cell anemia, for example.

The SPs perform their roles in person and are observed by staff, while the faculty facilitators and students observe the proceedings via videoconference.

Third-year medical student Mary Twarog has benefited from this new form of learning.

“I found the telemedicine training to be very helpful,” Twarog says. “This past year, our class has adjusted to fully remote didactic training in addition to our in-person clinical work, but we had not, until now, been able to implement our clinical training in a virtual way.”

Training via videoconference has been an adjustment for all involved, including the SPs.

“You need to make sure that the lighting is correct. In the case of a domestic abuse scenario, you need to make sure the makeup appears on camera. You also have to make sure you’re speaking up so everyone can hear you,” says Alysia Welch-Chester of Niagara Falls, one of the SPs. “And sometimes there are technology issues that can happen — a student’s feed freezing up or their internet may get a little shaky — so you have to be patient with that, on both ends. A lot of it is the normal things we’re all having to deal with in this pandemic.”

Students are finding that what works on patients with in-person training may need to change with telemedicine.

“One thing I personally realized in this session was the importance of making eye contact in the correct way. I hadn’t realized that if I do not look into my camera — and instead look at the patient on the screen — on the patient’s screen it appears that I am looking downward, giving the perception that I was distracted,” Twarog says. “We also faced the challenge of coming up with ways to comfort patients when physical touch is removed from our tool belt.” 

Andrew B. Symons, clinical professor of family medicine, was a facilitator for two of the sessions. He has incorporated this type of training as director of the clinical skills course — IDM 520/521 Clinical Practice of Medicine (CPM) — for first-year medical students.

He and CPM course coordinator Denise M. McGuigan worked closely with Zinnerstrom and her staff to convert the clinical simulation to a telemedicine format.

“I may have been the first course director to — out of necessity — adopt telemedicine education,” Symons says.

In the CPM course, students are trained to conduct a basic medical interview and perform a rudimentary physical exam on an SP.

The semester usually ends with every student interviewing an SP about a specific concern and obtaining a complete medical history.

“For most of the semester we convened the standardized patient seminars as hands-on experience crucial for developing the students’ clinical skills,” Symons says. “However, toward the end of the semester, with the increasing prevalence of COVID-19 infection in Western New York, we felt we should avoid bringing the students to school for this simulated clinical experience.

“Sometimes a cloud presents a silver lining,” he notes. “Prior to the pandemic, this technology was considered a novelty. Even when the pandemic passes, telemedicine will remain one of the tools we use to expand access for patients to medical care.

“I am pleased and proud that the Jacobs School has taken the initiative to train our students to provide care in this environment. It will serve them — and their patients — well.”