ABSTRACT
SETTING AND PARTICIPANTS: Online module, Ambulatory Internal Medicine Clerkship, 4th year medical students DESCRIPTION: Due to the COVID pandemic, the structure of the 4th year Advanced Ambulatory Medicine Clerkship at the Geisel School of Medicine at Dartmouth has been divided into two sections, two weeks in the clinical setting and two weeks of virtual cases. We developed an online module to teach students how to complete a high quality after visit summary, linked to one of the virtual cases. The module consists of the following activities: 1. A pre-module questionnaire to gauge student confidence in writing after visit summaries on a scale of 1 to 5 2. A 25 minute recorded lecture on After Visit Summaries. The lecture describes the essential aspects of the AVS for effective communication and patient comprehension, as well as components that meet CMS billing requirements. Information in the lecture was based on a literature review of surveys concerning what patients found the most helpful AVS components. 3. A virtual case from Aquifer concerning a 78 year old female who presents to clinic with falls, found to have orthostatic hypotension. 4. The students complete an AVS using a provided downloadable template that includes space for the following: Encounter Diagnoses, Problem List Diagnoses, Medication list with visit changes, Orders (including tests and referrals), Results, Provider Instructions, Follow-up 5. After submission of the worksheet, the students receive personalized feedback regarding the AVS they completed. The feedback is purely formative, as the assignment is graded as either Complete or Incomplete. 6. The students complete the same questionnaire as in step 1. EVALUATION: Quantitative data is gathered through the pre and postmodule questionnaires assessing student confidence. Preliminary data has been encouraging with improvement in the measured confidence scores. The question gauging student confidence in writing patient instructions showed an improvement from a mean score of 3.57, prior to the module, to 4.29, 95% CI [4.13, 4.45] out of a maximum score of 5 in a sample of 41 students. Students will also provide formative feedback to the program during clerkship evaluations. DISCUSSION / REFLECTION / LESSONS LEARNED: This AVS module is an effective learning exercise that improves the skills of learners in writing after visit summaries, a skill which may not be systematically taught in clinical settings. Utilization of a virtual case with skills practice followed by personalized feedback during the virtual portion of a clerkship, allowed for augmentation of didactic teaching that can be completed at students' own pace. The next steps in expanding the module, will be having students write an AVS for a patient encounter during their clinical weeks of the clerkship, with further feedback from their individual preceptors using a similar rubric utilized in the virtual case. This will allow us to take the next step in evaluating the module's effectiveness, via how well students apply the knowledge from the module in a real-life setting.