Telehealth Curricula in the Pediatric Core Clerkship: Results From a Survey of Clerkship Directors.

OBJECTIVE: Given the increasing prevalence of telehealth, medical students require dedicated instruction in the practice of high-quality telehealth. This study characterizes telehealth practices and curricula in pediatric core clerkships across the United States and Canada. METHODS: We surveyed pediatric core clerkship directors and site directors through the 2020 Council on Medical Student Education in Pediatrics (COMSEP) annual member survey. We analyzed the results using descriptive statistics. RESULTS: Of 104 medical schools represented, 28 responded (26.9%). Directors reported students spent little time on telehealth during their pediatric core clerkships (average 8.2% of clerkship; SD 10.4). Only 10.7% (n=3) of clerkships had dedicated telehealth curricula. The instructional methods, content, and modes of evaluation varied across the clerkships' curricula. Barriers to implementation of telehealth curricula included lack of dedicated time in the existing curriculum (64.0%), lack of faculty time to teach (44.0%), lack of curricular materials (44.0%), students not participating in telehealth activities (40.0%) and lack of faculty expertise (36.0%). CONCLUSIONS: Most pediatric core clerkships do not include dedicated telehealth curricula, and the characteristics of existing curricula vary. Considering the rapid adoption of telemedicine, pediatric core clerkships merit additional support and guidance for the training of medical students in telehealth practice.

Beyond Proximity and Towards Equity: A Multidimensional View of Urban Greenspace Access.

Park access is primarily conceived of as a question of proximity. We sought to develop a multidimensional tool based on a broad theory of green space access to better understand objective and subjective factors that capture varying dimensions of urban green space access that may be associated with its use. Methods: We conducted a cross-sectional study in two communities bordering a large park in Baltimore City, Maryland. We randomly selected households for an in-person survey conducted between April to September 2019. Our primary outcome was self-reported number of park visits over the last 30 days. The main independent variables conceptualized park access based on Penchansky and Thomas' theory of access. Results: Based on 87 respondents, living within a 10-minute walk was not associated with park use. Park use was associated with the perception that there were park events that individuals could participate in (adjusted IRR 6.83 [95% CI 2.57, 18.2]) and feeling safe in the park during the day (adjusted IRR 6.26 [95% CI 2.18, 18.0]). Those who reported that living near the park was affordable reported fewer park visits (adjusted IRR 0.53 [95% CI 0.32, 0.86]). Conclusions: Physical proximity was not significantly associated with green space use, but perceptions of safety, programming, and neighborhood affordability were. Our findings highlight the importance of subjective factors as part of a broader theory of park access.

Phone It In: A Medical Student Primer on Telemedicine Consultation in Pediatrics.

Introduction: Telephone triage requires a unique skillset that is not universally taught in medical school. This curriculum was developed to introduce third- and fourth-year medical students participating in their pediatrics core clerkship to the benefits, challenges, and mechanics of telephone triage. Methods: After completing a presession textbook reading and listening to a brief lecture, students participated in two telephone role-play scenarios with parents. The exercise required students to recognize the differences in acuity level of patients and provide appropriate guidance, management, and disposition instructions. Following the session, students completed a telephone note. Students evaluated this curriculum at the completion of the clerkship. Results: The majority of the 74 students who completed the 5-point Likert scale evaluation felt that the curriculum met its stated objectives (a score of 4 or 5 given by 82%), increased their knowledge (73%), engaged them (86%), and was of high quality (82%). Students specifically commented that the experience was useful, interactive, and applicable to their clerkship experience and future career. The most common area of constructive feedback was not understanding the purpose of a telephone note. Discussion: This easily implemented curriculum provided a foundational experience in the nuances of triaging and managing pediatric patients via the telephone. This serves as an important framework to prepare students for more complex telemedicine technology.

Improving Medical Students' OSCE Performance in Telehealth: The Effects of a Telephone Medicine Curriculum.

PURPOSE: To report on the implementation of a telephone medicine curriculum as part of the core clerkship in pediatrics for students at Johns Hopkins University School of Medicine and evaluate the curriculum's effect on student performance on a telephone medicine case as part of a required objective structured clinical exam (OSCE). METHOD: Using a prospective cohort design with a convenience sample of third-year medical students during the 2016-2017 and 2017-2018 academic years, the authors compared the OSCE scores of students assigned to the curriculum with both historical and concurrent control groups of students who had not received the curriculum. Additionally, the authors compared the costs of the recommended testing by students in each group using the 2018 Centers for Medicare and Medicaid Services Clinical Laboratory Fee Schedule. RESULTS: Students assigned to the telephone medicine curriculum (students in the intervention group) had a significantly higher mean overall score on the simulated OSCE telephone medicine case compared with the students in the control groups who did not receive the curriculum (the mean score for students in the intervention group was 7.38 vs 6.92 for students in the control groups, P = .02). Additionally, the intervention group had statistically significantly lower costs for their recommended testing compared with the control groups (the median value for tests ordered by students in the intervention group was $27.91 vs $51.23 for students in the control groups, P = .03). CONCLUSIONS: Implementing a dedicated telephone medicine curriculum for medical students improves their overall performance and delivery of high-value care via telephone medicine as part of an OSCE. Medical educators should pursue ongoing research into effective methods for teaching medical students and residents how to navigate digital encounters.