Reverse TeleMedstudent Implementation: Novel Dual-Video Platform for Clinical Education and in the Electrophysiology Clinic

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EP LAB DIGEST. 2024;24(8):26-27.

Ermin Tale, BS; Riya Kaushal, BA; Farage Ftiha, DO; Todd J. Cohen, MD
New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York

During the COVID-19 pandemic, Dr Todd Cohen and his team created a novel method to keep medical students engaged during clinical encounters with patients using a proprietary platform called TeleMedstudent, a dual-video HIPAA-compliant virtual platform that allows medical students to interface with clinicians and patients in real time. It was first implemented at the Long Island Heart Rhythm Center (LIHRC) as a method to overcome the difficulties of engaging medical students on clinical rotations during the pandemic. The TeleMedstudent platform was utilized at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) by the LIHRC and awarded first place at the 2020 Osteopathic Medical Education Conference for its utility in the medical education space.¹

During the initial wave of the pandemic, there was very limited, if any, in-person interfacing between medical students, doctors, and patients, and an alternative methodology needed to be found for to facilitate doctor-patient interaction. Since March 2020, TeleMedstudent has been used as an educational tool by the team at LIHRC. TeleMedstudent provides a method of treating potentially infected patients with COVID-19, with the virtual aspect of the visit protecting clinical staff and/or students. However, we discovered this method can also be used for affected clinical staff and/or students. In this article, we describe use of TeleMedstudent in the electrophysiology (EP) clinic, when lead physician Dr Cohen developed COVID-19 and could not participate an in-person clinical visit. 

About TeleMedstudent

TeleMedstudent utilizes 2 HIPAA-compliant simultaneous proprietary video platforms with screen sharing. This dual platform gives the clinician control over both video interfacing systems (including video and audio) and active participants’ commands during the encounter. With TeleMedstudent, physicians and health care workers can conduct virtual clinics while also using it as a medical education tool. Medical students can be allowed access to the encounter through the video platform, and patients can be allowed access through a completely separate platform. The clinician is able to simultaneously interface and monitor both platforms. Screen sharing allows one platform to communicate with another platform in real time. 

Figure 1 shows our workflow for appropriately using TeleMedstudent. It includes consent for third-party (ie, medical student) participation, which

must first be obtained from the patient using a video platform (ie, UpDox). If consent is not obtained or the patient does not give consent, the clinician and patient can continue their encounter without student participation. If consent is obtained, the clinician and student(s) can participate in the patient encounter. In NYITCOM’s TeleMedstudent format, medical students join the doctor-patient encounters through a HIPAA-complaint Zoom platform.

Reverse TeleMedstudent Implementation

The original intent of TeleMedstudent was for the virtual education of medical students in one location, their professor and educating doctor in another location, and a potentially infectious patient in this location. This series demonstrates “reverse” TeleMedstudent implementation. 

On February 27, 2024, a total of 19 in-person patient encounters were scheduled for cardiac evaluation with Dr Cohen in the LIHRC. Patient visits were scheduled for every half hour. Two days prior to the scheduled clinic date, Dr Cohen was diagnosed with COVID-19. The medical students scheduled for clinic that day were informed of the circumstance, and the team was faced with the decision to either cancel the clinic and reschedule patients, or convert the clinic to a virtual clinic. In the best interest of the patients, a virtual clinic was decided upon. All patients were contacted by phone and informed of this unforeseen circumstance. They were asked if they would prefer to convert their appointment to a virtual visit or reschedule their appointment. After confirming their choice, their type of encounter was updated accordingly. Eight patients opted to have their visit conducted virtually, while the rest of the patients (particularly those for cardiac implantable electronic device interrogation) were rescheduled to a different clinic day. 

Prior to their encounters, patients were asked to record all vital signs within their ability (eg, heart rate, blood pressure, temperature, etc) and

confirm their consent to medical student participation. When consent was given, their vital signs and personal health information were recorded in their electronic medical record (EMR) by the students. Students were also able to directly interact with patients (Figure 2) and assist with the encounters by gathering the chief complaint(s) and history of presenting illness, and performing medication, diagnosis, and allergy reconciliations. They also simultaneously scribed and retrieved important documents for the encounter, including remote transmission summaries of devices and recently completed lab/imaging studies. Before the encounter ended, the patient would be provided with a follow-up appointment.  

At the end of the encounters, after the patient had exited their session, the complete subjective, objective, assessment, and plan (SOAP) note would then be reviewed by Dr Cohen and his students. During this time, the note would be updated and modified accordingly and signed off. Teaching points regarding patients would also be made as well as any questions that students had addressed. Once finalized, any required billing and referral would be authorized and completed. Afterward, the next patient’s electronic health record would be retrieved to begin the next patient encounter. 

Discussion

This article emphasizes how this methodology can be used to pivot patient encounters and ensure continuity of clinical medical education when a physician cannot participate in person with their patients or medical students. A similar approach was first described in 2020 during the COVID-19 pandemic, as there was minimal interaction between doctors and patients, and its use has since been expanded.² Integration of the TeleMedstudent platform with HIPAA-compliant health care platforms (ie, Zoom/Updox/EMR system) is an effective method for ensuring that medical students are able to interact with patients and take part in clinic despite unforeseen circumstances, as in this case, when the doctor was actively infected with COVID-19.

The ability to quickly shift from in-person to virtual patient visits proved useful for medical students in the cardiology and EP clinic, and allowed for firsthand experience regarding continuity of care. Patients were also satisfied with use of this system, particularly using a video format. Chen et al reported similar findings with greater satisfaction across all domains of care with video visits when compared to in-person and audio-only visits; domains of care included access to care, provider care, and overall assessment of encounters.³ Overall, TeleMedstudent is a valuable tool that can benefit patients and physicians in training.

Even though the pandemic has ended, TeleMedstudent remains a valuable tool that can be utilized not only when patients are unable to attend in-person visits, but also with respect to infected medical students and their mentors/physicians. At the same time, it allows students to continue their medical education and remain immersed in medicine without being exposed to health risks. 

Figure 2 depicts TeleMedstudent in action with an example of a doctor-patient-medical student encounter. Dr Cohen and a patient are interacting using the telehealth platform Updox, while a medical student is seen also participating in the virtual encounter. The medical student is able to be involved in the encounter through screen sharing on a separate video platform (Zoom). They can directly communicate with both doctor and patient while also acting as a scribe, utilizing an EMR system. This triangulated method of interaction encourages doctor-patient-medical student interactions and allows for open communication between all parties. The value of and ability to integrate in-person and virtual clinical experience is also important for students, with the rapid shift of medical education to asynchronous and online learning.⁴  

Conclusions

This article outlines the ability to pivot a full clinic day at the LIHRC, on short notice, from in-person to virtual using TeleMedstudent. We highlight how our experience with TeleMedstudent can be implemented quickly during unforeseen circumstances to ensure continuity of care, regardless of the party affected, be it the physician or patient. Its mobility across various devices makes it a versatile and convenient tool that enhances medical education while also increasing accessibility and flexibility to medical professionals. Although the demand for telemedicine has waned since the pandemic, TeleMedstudent remains a valuable tool that can be used in emergent situations, while contributing significantly to medical education by exposing students to the realm of telehealth. It is a practical, effective alternative for delivering high-quality medical care to patients while ensuring the continuity of medical education to students. 

Learn more about the TeleMedstudent platform here: 
https://www.liheartrhythmcenter.com/telemedstudent

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest and report no conflicts of interest regarding the content herein. 

References

1. Coopee Z, Hunzeker N, Hubley R, Gitelman S, Cohen TJ. Implementation of a novel dual video telehealth platform during a cardiology clerkship during COVID-19 pandemic: TeleMedstudentTM (abstract). J Am Osteopath Assoc. 2020;120(12):e41-e42.

2. Dries E, Gitelman S, Cohen TJ. Rapid transition of a traditional cardiology/electrophysiology clinic to telehealth in the setting of an emergent pandemic. EP Lab Digest. 2020;20(5):31-34.

3. Chen K, Lodaria K, Jackson HB. Patient satisfaction with telehealth versus in-person visits during COVID-19 at a large, public healthcare system. J Eval Clin Pract. 2022;28(6):986-990. doi:10.1111/jep.13770

4. Mao S, Guo L, Li P, et al. New era of medical education: asynchronous and synchronous online teaching during and after COVID-19. Adv Physiology Educ. 2023;47(2):272-281. doi:10.1152/advan.00144.202