This student-led telephone-based clinical learning pilot program effectively provided health professions students with an opportunity to improve skills in patient-centered communication and health coaching via telehealth while identifying and addressing social, technological, and healthcare disparities faced by older adults. In line with prior literature, our results highlight the benefits of structured remote clinical learning experiences in helping students foster skills that can be especially valuable when working with and promoting health equity in vulnerable populations.21
Unlike traditional in-person clinical experiences for pre-clerkship students, this telephone-based clinical learning pilot program allowed non-essential health professions students to continue with direct participation in patient care of highly vulnerable patients during the COVID-19 pandemic, while also providing opportunities to practice workplace learning.22–24 Screening calls allowed students to apply clinical knowledge to triage healthcare concerns and unmet medical or social work needs. Social calls provided an opportunity to practice empathy-driven, relationship-centered communication in a longitudinal setting, since students were assigned to the same patients for the duration of their participation. Telehealth training calls challenged students to practice patient-centered health coaching skills, such as teach-back methods, with patients of varying technological literacy and accessibility. Our program went beyond the scope of other telephone-based medical student outreach programs developed for older adults during the pandemic in that we not only developed a multidisciplinary format to address patient needs, but also provided a structured educational experience for health professions students, who received academic credit for participation.25,26
Given that our program is not limited by logistical constraints such as clinic space or real-time clinical teaching by preceptors, this model of remote clinical learning can be easily adapted for students at other institutions longitudinally and implemented in partnership with outpatient clinics that serve many vulnerable patient populations beyond older adults. In particular, our program model could be beneficial for pre-clerkship students by providing early telehealth experience, direct patient interaction with vulnerable populations, and health communication skills training before beginning full-time clerkships. Our results confirmed that participating students overwhelmingly believed this program could be a beneficial supplement to pre-clerkship level students.
There were limitations in our program structure. Given the asynchronous nature of the telephone calls, student schedules, and faculty availability, there was no formal didactic component to the program. Students learned experientially through their patient calls and EHR work, relying heavily on self-directed learning and reflection.27 Further, given that we relied on students’ recall of pre-program knowledge gaps and attitudes by administering a retrospective post-program survey, our results could be limited by recall bias. Finally, due to the institutional policy that limited pre-clerkship medical students’ EHR use, these students could not route messages to clinic staff and thus received less opportunity to experience interprofessional collaboration. When developing similar programs, it would be important to consider institutional structural limitations, which may impact program operations and student experience.
To improve learner outcomes, future iterations of this program could incorporate structured didactics to provide greater context about challenges unique to older adults, as well as monthly virtual meetings for students and faculty to debrief as a community. Additionally, assignment of language discordant patients to each student could provide them with opportunities to practice using telephone interpreters with patients who have limited English proficiency, especially given that at least one-tenth of the clinic’s patients preferred to communicate in languages other than English.
In addition to providing a remote clinical learning experience, this outreach program supported older adults at an academic geriatrics primary care clinic. Telehealth training calls helped older adults access care necessary for managing chronic medical conditions independently during the COVID-19 pandemic, and were especially important because video telehealth visits were the primary method of healthcare delivery at this geriatrics clinic and most others during this time.28,29 We also found that this program impacted patients in ways we did not originally anticipate. The recommendation of physical distancing and shelter-in-place in response to the COVID-19 pandemic led to closures of community programs that many older adults rely on for socialization, increasing their vulnerability to social isolation and depression.30 In collecting anecdotal feedback, multiple students and PCPs reported that the screening and social calls not only improved patients’ feelings of social isolation, but also led multiple patients who had been lost to follow-up to reconnect with their healthcare providers. While other healthcare institutions have implemented screening protocols to identify the needs of older adults during this pandemic, to our knowledge our program is one of the first to describe methods with which a healthcare institution addressed underlying social challenges, particularly by providing social connection and video telemedicine education by health professions students.31,32