To the Editor:
Following the recommendation by the Association of American Medical Colleges on March 17, 2020, to suspend clinical rotations in response to the COVID-19 pandemic, medical students searched for opportunities to continue their education and contribute to patient care. Telemedicine provided that opportunity. We share our experience developing and staffing the Pandemic Follow-up Clinic (PFC), a telemedicine clinic which provided follow-up care to vulnerable patients.
We represent the Columbia-Bassett Class of 2022—10 Columbia University medical students who will complete their clinical year and receive advanced training in process improvement at the Bassett Healthcare Network (BHN).1 BHN serves 8 rural counties in upstate New York, all of which are federally designated health professional shortage areas for Medicaid-eligible populations. We designed the PFC to provide regular telephone visits to patients who had accessed care for possible COVID-19 cases. The clinic served patients managing symptoms from home, prioritizing those whose social or geographic isolation made them vulnerable to being lost to follow-up.
Under the supervision of an attending physician, we conducted follow-up calls with patients referred by emergency department staff, triage tent providers, and triage phone line operators evaluating possible COVID-19 cases. Between March 17 and April 10, 2020, we completed 2,176 calls with 1,009 unique patients. In each encounter, we practiced gathering a focused history, presenting to the attending, forming differential diagnoses, and recommending a disposition. The attending joined the patient calls to discuss symptoms, answer questions, and confirm 1 of 3 dispositions: referral to in-person evaluation, ongoing phone follow-up, or discharge. Teaching occurred in one-on-one encounters with the attending and in-group reflection sessions. We answered patients’ questions, providing reassurance and education on home management of their symptoms. We also gained experience recognizing patients in need of emergency care unrelated to COVID-19, such as a patient with previously undiagnosed pulmonary embolism and an uninsured patient with acute congestive heart failure.
Telemedicine is a useful means for engaging medical students in patient care, especially in times of crisis. We hope that other medical schools develop similar initiatives to train students in telemedicine, ensure continuity of care for vulnerable patients, and address the unique demands on our health system as a result of the COVID-19 pandemic.
The authors wish to thank Steven Heneghan, MD, for his assistance in the conception and implementation of this program and Robert C. Whitaker, MD, MPH, for his assistance in the preparation of this letter.
1. Weil HF. The shared context: Kaiser Permanente and the Columbia-Bassett Program. Perm J. 2016;20:91–92