COVID-19 vaccination telephone outreach: an analysis of the medical student experience.

INTRODUCTION: The COVID-19 pandemic diminished opportunities for medical students to gain clinical confidence and the ability to contribute to patient care. Our study sought out to understand the value of telephone outreach to schedule COVID-19 vaccines on medical student education. MATERIALS AND METHODS: Forty students engaged in telephone outreach targeting patients aged 65+ without active patient portals to schedule COVID-19 vaccines. Data consisted of a single administration retrospective pre/post survey inquiring about what students learned, expectations, other health-care processes that would benefit from outreach, and interest in a population health elective. Likert items were analyzed and open response analysis involved inductive coding and generation of thematic summaries by condensing codes into broader themes. Demographic data of patients called and subsequently received the vaccine were also collected. RESULTS: There were 33 survery respondents. There was a statistically significant increase in net comfortability for pre-clerkship students for documenting in Epic, providing telehealth care, counseling on common health-care myths, having challenging conversations, cold-calling patients, and developing an initial trusting relationship with patients. The majority called and who received the vaccine were non-Hispanic Black, within the high SVI category, and had Medicare and/or Medicaid. Qualitative data showed that students emphasized communication, the role of trusted messengers, the need to be open minded, and meeting patients where they are. DISCUSSION: Engaging students in telephone outreach early in the COVID-19 pandemic provided students the opportunity to develop their skills as physicians-in-training, contribute to combating the ongoing pandemic, and add value to the primary care team. This experience allowed students to practice patience, empathy, and vulnerability to understand why patients had not received the COVID-19 vaccine; this was an invaluable experience that helped students develop the skills to become empathetic and caring physicians, and supports the continued role of telehealth in future medical school curriculum.

COVID-19 Vaccination Telephone Outreach: A Primary Care Clinic Intervention Targeting Health Equity.

INTRODUCTION: Equitable COVID-19 vaccine access is essential to ending the COVID-19 pandemic. In many instances, COVID-19 vaccination notification and scheduling occurred through online patient portals, for which socially vulnerable populations have limited access. Our objective was to reduce disparities in COVID-19 vaccine access for the Black and socially vulnerable populations unintentionally excluded by our health system's patient portal-driven vaccine outreach through a telephone outreach initiative. METHODS: From February 1, 2021, through April 27, 2021, telephone outreach was directed towards patients aged 65 and older without patient portal access at a large urban academic general internal medicine clinic. Univariate and multivariate analyses between those who did and did not receive telephone outreach were completed to assess the odds of vaccination, accounting for outreach status, sex, age, race/ethnicity, payor status, social vulnerability index, and Elixhauser Comorbidity count. RESULTS: A total of 1466 patients aged 65 and older without active patient portals were eligible to receive the COVID-19 vaccine. Of these patients, 664 received outreach calls; 382 (57.5%) of them got vaccinated compared to 802 patients who did not receive outreach calls, of which 486 (60.6%) got vaccinated (P = 0.2341). Patients who received outreach calls versus those who did not were more likely to be female, younger, non-Hispanic Black, from high social vulnerability index census tracts, and have higher Elixhauser Comorbidity counts. Logistical analysis revealed an odds ratio (OR) with a nonstatistically significant trend favoring higher vaccination likelihood in the no outreach cohort with univariate analysis with no changes when adjustment was made for age, sex, race/ethnicity, payor, social vulnerability index, and Elixhauser Comorbidity count (univariate analysis: OR 0.88 [95% CI, 0.71-1.09]; model 1: OR 0.89 [95% CI, 0.72 - 1.10]; model 2 - 0.89 (0.72 - 1.11); model 3: OR 0.87 (95% CI, 0.70 -1.09)]. CONCLUSIONS: While our telephone outreach initiative was not successful in increasing vaccination rates, lessons learned can help clinicians and health systems as they work to improve health equity. Achieving health equity requires a multifaceted approach engaging not only health systems but also public health and community systems to directly address the pervasive effects of structural racism perpetuating health inequities.

Telehealth and Medical Student Education in the Time of COVID-19-and Beyond.

The COVID-19 pandemic continues to limit medical students' full reintegration into clinical learning environments, thus exacerbating an ongoing challenge in identifying a robust number of clinical educational activities at excellent clinical sites for all students. Because medical students across the United States were removed from direct patient care activities in mid-March 2020 due to COVID-19, medical centers have prioritized and implemented changes to the process of patient care. As some barriers are being lifted in the face of a highly contagious and deadly infection, the use of telehealth (delivery of health services remotely via telephone, video, and secure messaging), although not new, is rapidly expanding into all aspects of patient care. Health care providers have been encouraged to conduct many interactions at a physical distance. Telehealth largely replaced face-to-face visits for nonemergency care in an attempt to slow viral transmission while enabling physicians to continue to deliver patient education, manage acute and chronic illness, and nurture caring doctor-patient relationships. Health care providers, many of whom were initially reluctant to embrace telehealth technology and logistics, are becoming nimbler and more aware of the many positive aspects of telehealth. The authors suggest that integrating medical students into telehealth activities would help maintain and improve patients' health, extend the capabilities of health care teams and systems during and after the pandemic, and increase medical students' opportunities for experiential learning and professional identity formation. The authors expand on these 3 goals, suggest several concrete student telehealth activities, propose a curricular strategy, and outline opportunities to overcome key barriers to full alignment of telehealth and undergraduate medical education.

Teaching Physical Examination to Medical Students on Inpatient Medicine Teams: A Prospective, Mixed-Methods Descriptive Study.

Physical examination (PE) is a core clinical competency, and the internal medicine clerkship is a premiere venue for students to develop PE skills. However, clinical rotations often lack opportunities for real-time instruction. We sought to measure the frequency, content, and factors affecting PE instruction during the internal medicine clerkship. We conducted a prospective mixed-methods study at a single academic center. Data were gathered by a student researcher who directly observed inpatient teams over 3 months. We quantified the frequency of PE teaching activities and analyzed daily written observations using qualitative content analysis. PE was most frequently discussed during bedside rounds and least often during workroom rounds. Direct observation of students' examinations rarely occurred. Multiple factors in the learning environment were posited to affect PE instruction. In brief, we found that residents and attending physicians who are part of internal medicine teaching services do not routinely emphasize PE instruction.