key: cord-1021722-daroxzuf
authors: Wateridge, Matthew J.; Chapman, Lucy C.
title: Clinical Support and Practice: U.K. Medical Students as Clinical Support Workers During COVID-19
date: 2021-06-08
journal: Acad Med
DOI: 10.1097/acm.0000000000004198
sha: 43c2c790215edd0b72c45369e23206c0abd763eb
doc_id: 1021722
cord_uid: daroxzuf

nan

To the Editor: Incorporating clinical experience into the preclinical years of medical school is vital to prepare students for clinical rotations. We present our experience leading and staffing the Cardiac Coaches program, a student-run pilot program that provides lifestyle-based counseling for recovering acute coronary syndrome (ACS) inpatients, including a telehealth counseling model we implemented during the COVID-19 pandemic.

The University of Maryland School of Medicine's Cardiac Coaches program was established in 2018 to provide lifestylefocused secondary prevention of coronary artery disease in an inpatient setting. Participating students undergo 8 hours of behavioral change counseling training with a faculty cardiologist and meet independently with stable, recovering ACS inpatients before discharge. As coaches, students assess their patients' values and goals and work with them to identify a series of small, actionable postdischarge goals regarding diet, exercise, and tobacco use. Afterward, students debrief with a faculty cardiologist and follow up with the patient 7 to 14 days postdischarge to reassess their progress and goals.

When the COVID-19 pandemic forced us to halt in-person patient coaching, we created a new telehealth model of cardiac coaching, using Doximity Dialer, a free telehealth app that allows secure audio and video calls to patients. We encountered multiple challenges, such as technical problems and difficulty establishing rapport in a virtual environment. However, this also led to new opportunities, like the ability to reach patients at their convenience rather than ours (including after discharge) and the ability for multiple students to "shadow" a coaching session simultaneously. As of April 2021, nearly 25% of every cardiac coaching session since the program's inception has been done via telemedicine. We anticipate eventually transitioning to a hybrid model to capture the best of both models.

From the perspective of students whose days consist of watching Zoom lectures from home, each remote cardiac coaching session we have run has been priceless. We have gained not only unanticipated experience with telemedicine, but also a sense of purpose from contributing to patient well-being during a global crisis. We share our experience in hopes of inspiring other medical schools to provide similar and uninterrupted clinical learning opportunities to preclinical students throughout the COVID-19 era and beyond.

Acknowledgments: The authors would like to thank Drs. Rebecca Lolley and Jonathan Ludmir, who as trainees, helped create the Cardiac Coaching Program. The authors would also like to thank the University of Maryland cardiovascular disease fellows who volunteer to coordinate the program and identify appropriate patients for the program. Clinical Support and Practice: U.K. Medical Students as Clinical Support Workers During COVID-19

To the Editor: As medical students in our penultimate year at Warwick Medical School in the United Kingdom, our medical education has been affected by the COVID-19 pandemic. Recognizing the falling staff numbers in our local trusts due to self-isolation, along with the inevitable pause in studies during the first national lockdown, our medical school offered students the opportunity to work as clinical support workers (CSWs). We wish to share the role that we took on as CSWs/ medical students within an Accident and Emergency (A&E) Department and advocate for additional experience in acute settings within the medical curriculum.

This hybrid role, based on the important duties of a conventional CSW, also provided the opportunity for performing vital clinical skills such as venepuncture and peripheral venous cannulation. Competency in these skills is essential but, possibly due to varying requirements by different medical schools, is not universally obtained. Studies have revealed that approximately 20% of finalyear medical students have not performed either venepuncture or peripheral venous cannulation, 1,2 a worrying statistic, considering that competence in these skills requires repeated practice.

With nearly all patients in A&E requiring such procedures, we gained regular practice throughout shifts. This enabled us to go from having never cannulated a patient to being proficient and confident within a relatively short space of time. Meanwhile, our peers who did not take up this role found themselves regretting not having had the same opportunity to practice their clinical skills.

Going forward, we propose that other students are offered the opportunity to be CSWs by their institutions and are encouraged to practice their clinical skills on a regular working basis within acute medicine. This would have the dual benefit of providing an invaluable opportunity for students to become more confident in their clinical skills, as well as lessening the burden on A&E staff. Therefore, we would be interested in hearing the thoughts of those working in both medical education and acute medical settings as to whether this could be viable.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Third-year medical student, University of Warwick Faculty of Medicine, University of Warwick Medical School, Coventry, United Kingdom; matt. wateridge@warwick.ac.uk; ORCID: https://orcid. org/0000-0001-5927-2463.

To the Editor: As U.K. medical students whose clinical placements were suspended in March 2020, the views expressed by Schuiteman and colleagues 1 on the importance of bridging communication barriers particularly resonated with us.

COVID-19 lockdown measures brought a halt to in-person teaching and clinical placements for medical students across the United Kingdom. Summative examinations for the academic year at our medical school were also postponed and later moved to online proctoring systems. Having been suspended from placement and isolatednot only from medical school but from our peers, too-there was much concern surrounding online examinations. Bridging the communication gap between medical students and medical school administrators was key in easing increasing worry among students and to provide a more manageable workload for the university in a time of great uncertainty.

To this end, our medical school made use of an online forum to facilitate the dissemination of information to students; this included updates on changes to lockdown measures, examination updates, and directions to well-being services. This forum helped ensure we were kept up-to-date on current guidance, and it alleviated much unrest among students. Effective communication, however, also involved sharing the student opinion in a manageable way. To address this, the Student-Staff Liaison Committee (SSLC) was employed to gather and communicate the medical student opinion. SSLC representatives were able to share the views and concerns of students with the medical school, providing an effective and manageable means of communication.

The importance of a student representatives council has been previously discussed. 2 Here, we demonstrate its importance in facilitating the communication of the medical student opinion in unprecedented times and its role in addressing student concerns. Like the authors, we agree that the value of an effective working relationship between the student government and medical school administration has been demonstrated during the COVID-19 pandemic, and we recommend the use of online forums and SSLC representatives in all future crises' events involving medical schools.

Funding/Support: None reported.

Other disclosures: None reported.

The COVID-19 Pandemic Is an Opportunity to Enhance Research on Remote Digital Anatomy Teaching Platforms To the Editor: It was our pleasure to read Pearson's comments, 1 which raise important issues about the restriction of cadaver-based anatomy education due to the COVID-19 pandemic. We agree that disruption of cadaveric dissection could be accompanied by negative consequences because it has proven valuable for medical students regarding acquisition of anatomical knowledge. 2 We also agree that this method could lead to development of compassion and empathy 1,3 because medical students can encounter death and consider the cadaver as their first patient. 3 Pearson implies that future patients' care by physicians could be compromised if cadaveric dissection diminishes. However, despite the aforementioned value of cadaveric dissection, we note that, to the best of our knowledge, there is lack of evidence that patients' care declines if physicians have not received cadaver-based education.

We believe that recent findings of anatomy education research, concerning 3-dimensional (3D) digital visualization technologies, should be taken into account. Until recently, cadaveric dissection had not been found inferior to any digital anatomy teaching method. Nevertheless, Ruthberg and colleagues 4 have recently demonstrated that the examination performances of a group of students taught anatomy via a 3D visualization technology (mixed reality) did not significantly differ from those of a group of students taught anatomy via dissection. Moreover, mixed reality was found to be more time-efficient than dissection. 4 Zibis and colleagues 5 compared the performances of 4 groups of students, each of which were taught anatomy via 4 different methods: a 3D digital platform, plastic models, cadaveric dissection, and prosection, respectively. The participants in each of the 4 groups were asked to identify anatomical structures in projected images. The students who received teaching via the 3D digital platform performed significantly better than did those who learned anatomy with the remaining 3 methods.

Thus, although cadaveric dissection has a high educational value, 2 this method should not be considered as definitely superior to digital technologies in terms of knowledge gain. It seems that, due to the COVID-19 pandemic and the shift to remote digital anatomy teaching platforms, 1 a remarkable opportunity arises for enhancement of research concerning these platforms. Continuously evolving 3D digital visualization technologies have shown remarkable potential to enable acquisition of anatomical knowledge. 4,5 This knowledge could be the basis for high-quality care to future patients.

The role of medical student government in responding to COVID-19

Representation and student engagement in higher education: A reflection on the views and experiences of course representatives

Ethical approval: Reported as not applicable.

Third-year medical student, Warwick Medical School, University of Warwick, Coventry, United Kingdom; elena.whiteman@warwick.ac.uk; ORCID: https:// orcid.org/0000-0003-2451-1967.

Third-year medical student, Warwick Medical School, University of Warwick, Coventry, United Kingdom; ORCID: https://orcid.org/0000-0002-1208-4104.First published online June 8, 2021