Student-Led Adaptation of Improvement Science Learning During the COVID-19 Pandemic.

INTRODUCTION: In response to the COVID-19 pandemic and the restriction of students participating in face-to-face instruction, two medical students rapidly adapted a preclinical curriculum that virtually teaches improvement science and equips learners with the knowledge to address patient needs. METHODS: Eight first-year medical students participating in a longitudinal patient navigation and health systems science program completed 15 interactive video sessions. After learning about the Model for Improvement and various quality improvement tools, students worked in teams of four to conduct several plan-do-study-act cycles. Postsession surveys captured student satisfaction, session feedback, and reflections about conducting improvement work. Two medical students then applied conventional content analysis to identify themes to describe the data. RESULTS: Student projects focused on addressing patients' health care and social resource needs through telephone and electronic interactions. Five themes were identified in the survey results: (1) learning by doing in the dynamic nature of improvement work; (2) enjoyment of virtual team-based learning; (3) project relevance to COVID-19; (4) utility of quality improvement tools; and (5) continuous curriculum improvement with student feedback. CONCLUSIONS: In this student-led endeavor, we implemented a virtual improvement curriculum where first-year medical students apply improvement science knowledge to patient needs during the COVID-19 pandemic. Results demonstrate the feasibility of teaching improvement in a virtual setting where learning is action-based with project work being relevant to health care priorities. Our work provides a framework for others to continue teaching this integral component of medical education.

COVID-19 and Telehealth: Prevention of Exposure in a Medically Complex Patient With a Mild Presentation.

The novel coronavirus disease-2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. We discuss a less common presentation of COVID-19 in a patient where the use of telemedicine technology prevented the exposure of the healthcare team in an academic general pediatrics clinic. A medically complex 20-year-old male presented via virtual visit for unilateral eye redness and discharge. He received topical ophthalmic antibiotics for presumed acute bacterial conjunctivitis and was counseled on return precautions. Three days later, the patient developed shortness of breath, fever to 102.6°F, and chest pain. COVID-19 testing returned positive. Conjunctivitis is a presenting symptom in 32% of COVID-19 cases. Current evidence suggests that these patients may transmit their illness at the time of presentation. Using telehealth, we avoided exposure to a COVID-19-positive patient who would not have met criteria for testing or droplet precautions. Telehealth allows providers to triage patients, identifying those who need to be seen in person, thereby minimizing exposure. Transitioning toward virtual practice, particularly during a pandemic, prepares for the possibility of healthcare workers being quarantined but still able to provide care and minimizes exposure to asymptomatic patients or those with atypical symptoms.