April 23, 2020

VUSM students help patients, clinicians with telehealth

When in-person visits to Vanderbilt Eskind Diabetes Clinic needed to be quickly converted to telehealth appointments in response to COVID-19, a novel solution was hatched to bring both clinicians and patients up to speed on videoconferencing.

Fourth-year VUSM student Emily Long assists Paul Epstein, MD, as he conducts telehealth visits with patients of the Vanderbilt Eskind Diabetes Clinic.
fourth year Medical Student Emily Long assisting Dr. Paul Epstein as they conduct telemedicine calls with endocrine/diabetes patients.
Fourth floor of Oxford House, in the fellows room Endocrinology/Diabetes area
Photos by: Susan Urmy

When in-person visits to Vanderbilt Eskind Diabetes Clinic needed to be quickly converted to telehealth appointments in response to COVID-19, a novel solution was hatched to bring both clinicians and patients up to speed on videoconferencing.

Vanderbilt University School of Medicine (VUSM) students completing their upper-level Immersion course at Eskind Diabetes Clinic didn’t blink when asked by Michael Fowler, MD, associate professor of Medicine, to instead become instant telehealth consultants.

“These third- and fourth-year students would ordinarily have spent about half the day taking care of patients with diabetes and half the day studying and doing research,” said Fowler, who co-directs the Immersion course with Al Powers, MD, director of the Division of Diabetes, Endocrinology and Metabolism and the Vanderbilt Diabetes Center. “But then COVID-19 happens and after just two of their four weeks, they’re pulled out of their clinical rotations.

“The students really, really wanted to help, and they were understandably frustrated that they couldn’t be in the clinical environment. So, what Al and I decided to do was to put students in charge of, one, educating providers about how to use the Zoom videoconferencing app and Epic for telehealth appointments to connect with patients; and two, calling patients ahead of their appointments to help them learn how to get logged in and communicate with their providers.”

Eskind Diabetes Clinic’s older patients and patients living in rural areas were anticipated to have challenges getting connected, and older, more at-risk faculty members who had been asked to work remotely often had less experience with conducting telehealth appointments, but as soon as the four medical students pivoted to troubleshoot and assist, things began working smoothly.

“They’ve just done a spectacular job,” Fowler said. “In a situation like this, it would have been easy for them to throw up their hands and say, ‘Well, our clinical experience is over,’ but they genuinely rose to the occasion. They made a real difference for our patients and our providers.”

Medical students Shaunak Amin, Thomas Day, Emily Long and Zijun Zhao connected with faculty members who needed assistance downloading the Zoom app onto their computers or devices and worked through any issues with them.

Then, they divided up lists of patients with upcoming appointments and called each one, taking as much time as needed to answer all of their questions and make sure they were prepared for their telehealth visit.

Janie Lipps-Hagan, ANP-BC, who works at Vanderbilt Eskind Diabetes Clinic, emailed Fowler and Amin to express gratitude for the help.

“Shaunak called all three of my patients before their visit and got them set up for their visit,” she wrote. “Each patient expressed their thanks for his help. I heard him talking with the patients in a kind and patient way as he worked them through technology issues with success for all three visits.”

“We’re just so grateful that we were in a position to help,” said fourth-year student Amin. “We were able to sit and spend time virtually with each patient and work out any issues they might have so providers on the front line could focus on taking care of the patient during the telehealth visit.”

Amin, who matched into the University of Washington-Seattle’s ENT program, said this wasn’t at all how he expected medical school to end, but he’s grateful to Fowler and Powers for turning the situation into something beneficial for everyone.

Emily Long, who matched into the Beth Israel Deaconess Medical Center/Harvard Plastic Surgery program, said she was also grateful for the opportunity to assist clinicians and patients with telehealth visits.

“Our medical school experience ended in a way that I don’t think any of us could have expected, but I also think we were reminded of why we all went to medical school, which was to help people,” Long said. “It’s been an interesting couple of weeks, but it was rewarding.”

Long called clinic patients to answer any questions they might have about telehealth. She laughingly reported that patients in their 20s said they were ready, “No worries!”

And even though the medical students weren’t able to be there in person to observe the clinical appointments, if patients gave their consent, they could join in on telehealth visits.

“So even though I was in my living room on my couch, by joining the telemedicine visit, I could essentially be in the exam room and learn from the providers, which I think is such a unique experience.”

Long also worked for the past four years at the Shade Tree Clinic, the medical student-run free clinic for underserved individuals in Nashville, co-directed by Fowler.

She’s excited about the possibility of the clinic using telehealth more extensively in the future as many patients work during clinic’s hours or have limited access to transportation.

“I honestly think this will change how we view health care and medical education,” she added. “What we can take away from this is that there are a lot of ways to learn medicine. I think this is something we’re going to look back on 10 years from now and say, “Why didn’t we do this all along?”

Medical students Kaustav Shah, Austin Triana and Roman Gusdorf also stepped up to serve as student leaders to coordinate volunteer efforts to support telehealth efforts for all of Vanderbilt Health’s approximately 90 adult Medicine clinics.

Gusdorf, a second-year medical student, was completing his Pediatrics clerkship when everything changed, but said he was grateful for the opportunity to contribute to the provision of medical care by coordinating telehealth volunteers.

“I was distressed to have my clerkship interrupted, and I was longing for a way to continue serving our patients in this difficult time,” he said. “Helping develop this telehealth program has been the perfect avenue to make a difference in the lives of my community, even while having clinical duties suspended.

“Witnessing the Vanderbilt students and faculty rally quickly around this cause has given me hope in a dark time. The gratitude I’ve received from the patients I’ve helped, the providers I’ve assisted and from fellow students who were also eager for a way to help in this awful situation, has given me the motivation to keep building upon this program.”

With assistance from Sara Horst, MD, MPH, associate professor of Medicine, and Michelle Griffith, MD, assistant professor of Medicine, student leaders put together a training manual for medical students to guide them as they made calls to patients with upcoming telehealth appointments. They then developed a spreadsheet listing all the clinics and assigned medical students to support telehealth outreach for the clinics. The medical students were able to assist individual patients as they set up their My Health at Vanderbilt access and downloaded the Zoom videoconferencing app in preparation for their upcoming telehealth visits.

Approximately 75 medical students were trained and volunteered their time to call patients. During just the first two days of providing this assistance, medical student volunteers contributed more than 80 hours as they reached out to more than 500 patients with upcoming clinical appointments.