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Grant helps medical students experience telemedicine during neurology clerkship

The one-year, $2,500 grant announced in April is one of just 14 the alliance gave to educators across the country.

Man sits in front of laptop computerIf there's an upside to a health crisis like the COVID-19 pandemic, it's that it encourages innovation and accelerates change.

"The pandemic has, in many ways, forced physicians to adapt to the telemedicine approach as a way of bringing care to patients in their own homes," said Tiffany Schwasinger-Schmidt, M.D., Ph.D., an internist and assistant professor who directs the neurology clerkship at KU School of Medicine-Wichita.

As clinics largely shut down, many practicing physicians learned quickly how to deliver care via the internet, driven by the need to continue to serve patients and enabled by the relaxation of regulatory barriers. But a grant Schwasinger-Schmidt recently received aims to more systematically answer the question: "How do you really teach telemedicine?"

Fortunately, "we've all learned a lot about telemedicine in a short period of time, and there's a lot of new expertise" to apply to that question, she said.

A native of Goodland in northwest Kansas, Schwasinger-Schmidt is one of many medical school faculty who have explored how to provide care - especially in subspecialties - to rural and other underserved communities across Kansas. This interest led her last year to apply for an innovation grant from the Alliance for Academic Internal Medicine.

The one-year, $2,500 grant announced in April is one of just 14 the alliance gave to educators across the country. Collaborating with neurology clerkship directors in Kansas City and Salina, Schwasinger-Schmidt said, the money will be used to develop a curriculum for the approximately 210 third-year medical students who go through the clerkship each year.

The curriculum will draw on not only the expertise gained during the pandemic, but also from other educators and community partners who had already been using telemedicine to provide medical care.

"Nowhere in our curriculum to date do we teach students about telemedicine - what to do when the computer crashes, how to conduct an accurate physical exam without touching a patient, how to incorporate telemedicine into a practice model, or information regarding reimbursement," Schwasinger-Schmidt said. "The goal is to provide a basic understanding of how it can work and how they can best support their practice and their future patients."

"We are going to build online modules that explain the background of telemedicine, what kind of equipment you need, how to protect patients' information, how to do a physical exam -especially a neurologic exam - on patients," she said.

A key component will be a virtual simulation with a standardized patient. The sessions will teach students how to obtain information from a patient during a virtual visit, and then gain feedback from a preceptor on how the student can enhance their performance.

Adult medicine and Alzheimer's care are among Schwasinger-Schmidt's practice and research interests, and the expanded use of telemedicine has shown the benefits of being able to see a patient in their home.

"Through telemedicine you can learn about how patients live and the challenges they face at home. Physicians can see what medications the patients are actually taking at home and better instruct patients on medication use, including how to best use an inhaler. You gain a better understanding of patient needs by working with them in their homes, which allows us as physicians to ultimately provide better care," she said.

Yunxia Wang, M.D., a neurologist, is the clerkship director on the Kansas City campus. She and her Kansas City colleagues have used telemedicine for stroke care across Kansas for several years. Students have been exposed to telemedicine through rounds there, but it hasn't been a formal process.

Like Schwasinger-Schmidt, Wang sees great benefits to observing patients in their natural environment. A doctor can gain an appreciation of whether a medication is affordable, or whether the home is safe for a stroke patient. "We can see how the furniture is set and can send a visiting nurse who can teach patients how to prevent falls," Wang said.

The planned curriculum provides an opportunity beyond the rapid training many doctors underwent recently, Wang said. Additional training could cover what kinds of care can and cannot be done through telemedicine. Instruction can also define for students what "telemedicine" encompasses, listing possibilities ranging from telephone calls to video feeds to apps that can monitor blood sugar and heart rate.

"The development of new and innovative curriculum is a passion of mine," said Schwasinger-Schmidt, who mentions that the medical school's ACE curriculum instituted three years ago demonstrates the advantage of exposing students to clinical care early and often.

"With simulations like the one planned in this grant, students are so immersed in the process of learning that they forget they're learning," she said. "Students in the new curriculum are learning things in the first few weeks of medical school that took us the entire first year to figure out. They're challenging us as educators in ways we had never anticipated, because they know so much more."


KU School of Medicine-Wichita