Guidelines for Pre-Clerkship Clinical Activities


Contents

I. Introduction and Guiding Principles

II. Curricular Clinical Activities

III. Para-curricular Activities

IV. Clinical Research

V. Professionalism

VI. Summary of Pre-Clerkship Curricular Sessions Involving Patients/SPs

VII. Summary of Para-curricular Activities involving Direct Patient Care

VIII. Summary of Research Activities Involving the Clinical Environment

 

I. Introduction and Guiding Principles

Guidelines for Involvement of Pre-Clerkship Students in Clinical Curricular, Para-Curricular, and Research Experiences

Our primary goal is to engage our pre-clerkship medical students in the clinical environment as soon as possible, while simultaneously protecting the welfare of our students, patients, and community.  We believe that immersion in the clinical environment helps students make sense of scientific principles and allows for integration of health systems sciences topics.  The patient as a central focus for medical education makes for meaningful learning that fosters relevance, applicability, and purpose.

The following principles guide our decision making on how to engage pre-clerkship students in clinical curricular, para-curricular, and research experiences during the COVID-19 pandemic:

  1. We will continue to deliver high quality medical education at PSOM through innovative practices that will meet our curricular goals. 
  2. We will continue to prioritize the safety of our students, patients, and community.
  3. We will limit all educational formats that increase risk of COVID-19 transmission in favor of other methodologies that promote learning.
  4. Due to physical distancing requirements, we will prioritize required clinical learning experiences for MS 3 and MS 4 students (i.e. clerkships, sub-Is, clinical electives) over pre-clerkship elective and volunteer clinical experiences.
  5. We will preserve PPE for essential and critical activities, as necessary.
  6. We will prioritize activities where students are considered essential to the care of the patient and/or community.

Clinical experiences for pre-clerkship students are defined as any activities in which our medical students engage in direct contact with patients, standardized patients, or members of the community.  Clinical engagement may occur during 1) curricular activities, 2) para-curricular activities (i.e. volunteer activities), and 3) clinical research activities.  The remainder of this document details how PSOM will address pre-clerkship student involvement in each domain, using the guiding principles.

 

II. Curricular Clinical Activities

1. Required and Elective Courses Involving Patients

The following required pre-clerkship course involved patients during the pre-COVID curriculum: 

MS 1

MS 2

  • LEAPP
  • Primary Care Pathway
  • LEAPP
  • Pediatric ICM
  • Primary Care Pathway

MS 1: LEAPP begins January 2021 for MS 1 students.  If we can follow the guiding principles outlined above, we will accommodate in-person LEAPP activities in 2021.  However, if the pandemic prevents us from following the guiding principles, we will adjust the curriculum and utilize alternative modalities such as telehealth and virtual cases.  The Primary Care Pathway patient encounters will occur via telehealth.

MS 2: LEAPP resumes Fall 2020 for MS 2 students.  All LEAPP sessions for MS 2 students will be transitioned from live patient visits to remote patient telehealth interactions.  Pediatric ICM inpatient encounters will occur in-person at CHOP or via telehealth.  The Primary Care Pathway patient encounters will occur via telehealth.

2. Required Courses Involving Standardized Patients 

The following required pre-clerkship courses involved standardized patients (SPs) employed by the PSOM SP program during the pre-COVID curriculum:

MS 1

MS 2

  • ICM FIRST
  • Anatomy: Introduction to Ultrasound
  • Adult ICM
  • Cardiology (U/S sessions)
  • Differential Diagnosis
  • Pre-Clerkship Week

SPs from the PSOM SP Program will be used only remotely during the COVID-impacted curriculum.  Medical SPs (upper year students, residents, fellows, and non-evaluating faculty who may participate on rare occasions) will be employed for in-person activities.  We will also consider simulations and/or online applications for select sessions. 

3. Non-Credit Elective Courses Involving Standardized Patients

The following elective pre-clerkship course is considering using SPs during the COVID-impacted curriculum:

MS 1

MS 2

  • Medical Mandarin
  • Medical Mandarin

Any non-credit electives involving patients or SPs will be transitioned to remote opportunities (i.e. telehealth or virtual cases).  SPs were not used during the pre-COVID curriculum for Medical Mandarin but the elective directors are considering utilizing SPs in 2020.  We will either postpone SP consideration until 2021 or consider remote SPs.

 

III. Para-curricular Activities

During the COVID-19 pandemic, the Assistant Dean for Community Engagement, will evaluate each of the existing para-curricular activities (categorized below) and ensure that the programs are set up to receive students safely. We will prioritize para-curricular opportunities where students serve as members of the critical health care workforce as referenced in the 8/14/2020 AAMC guidelines.  Each individual para-curricular program will submit a safety contract to the Assistant Dean for Community Engagement for approval.  The safety contract will delineate how the program will ensure student, staff, and patient safety during the pandemic, a timeline for opening the program, and contingency plans should COVID-19 rates change in the community, should there be changes in availability of PPE or testing, or exposures occur within the community clinic.

Once the para-curricular activities have been vetted and approved by the Assistant Dean for Community Engagement, students and their faculty advisors may begin preparations for re-opening their community clinics.  Any student involved in these volunteer activities must sign a form stating they understand the strictly volunteer nature of the activity, the risks/benefits of the volunteer activity, and a commitment to adhere to all protocols necessary to limit COVID-19 transmission.  We will prioritize students with more advanced clinical training (i.e. MS 3 and MS 4 students) in para-curricular activities that require advanced patient care.

We will also create additional remote volunteer opportunities for pre-clerkship students as needed.  See below for a summary of the various para-curricular activities and how each type of activity will be managed during the pandemic.

1. Student-led Community Clinics

Please refer to the following student-led community clinics as a guide.  Each faculty advisor will work with the Assistant Dean for Community Engagement to ensure their specific program is ready to accept students.  All students will need to sign a safety contract prior to beginning their participation in community volunteer work. 

2. Education and Patient Outreach Opportunities

Please refer to the following education and patient outreach opportunities as a guide.  Each faculty director will work the Assistant Dean for Community Engagement to ensure their specific program is ready to accept students.  Where possible, virtual activities are recommended.  All students will need to sign a safety contract prior to beginning their participation in community volunteer work. 

3. High School Student Mentoring

Please refer to the following high school student mentoring opportunities as a guide.  At this time, we will suspend in-person mentoring sessions in favor of remote mentoring opportunities.  The Assistant Dean for Community Engagement will assess the situation each month.  Once the situation improves, the programs can transition to live mentoring sessions as needed.  

4. Hospital and Clinic-based Volunteer Activities

Certain volunteer activities require students to interact with patients in the clinical setting.  Any students requesting additional volunteer opportunities that require them to engage with patients in the hospital or clinics should contact the Assistant Dean for Community Engagement and the Associate Dean for Clinical and Health Systems Sciences Curriculum for approval.  The student must provide information detailing the type of volunteer activity and safety plan.  The activities can only be approved if students are considered part of the critical healthcare workforce and if the activity adheres to the guiding principles outlined above.

5. Shadowing

In-person shadowing opportunities will not be available to students at this time.  While we value these opportunities for our student learners, we must limit any activity that could enhance the spread of COVID-19 and could further limit physical distancing in the clinical environment.  Student can still participate in virtual shadowing via telemedicine if able.

 

IV. Clinical Research

Non-clinical research and any clinical research that does not require students to interact with patients in person or utilize the clinical environment should continue per Biomedical Graduate Studies (BGS) guidelines.

Some students may require research involving direct patient care or visitation to the hospital. Students requesting these types of research should complete the form online found here. for approval. Approval will be based on whether the research meets the guiding principles and whether you can abide by the safety and preparation rules.

 

V. Professionalism

All students involved in patient care must adhere to the standards of professionalism outlined in the Penn Compact.  All MS 1 and MS 2 students must sign a COVID-19 safety contract prior to participating in any direct patient care.  Any students participating in para-curricular volunteer activities must also sign a safety contract prior to starting their activity.  

 

VI. Summary of Pre-Clerkship Curricular Sessions Involving Patients/SPs

MS 1 Curricula

Course

Dates

Pre-COVID Curriculum

COVID-Impacted Curriculum 

ICM FIRST

  • Intro Hx/CC
  • Intro Hx/Soc Hx
  • Intro to IPE
  • Pt Communication

8/20– 11/20

  • SPs from PSOM SP program
  • RSPs from PSOM SP program
  • RSPs from Villanova for Intro to IPE

Intro to Anatomy 

  • Ultrasound sessions

10/20

  • SPs from PSOM SP program utilized
  • RSPs from PSOM SP program
  • Medical SPs

Intro to Ultrasound

Spring ‘21

  • SPs and student volunteers utilized
  • Medical SPs
  • ? web-based application

LEAPP

1/21

  • Home visits/live patient visits
  • Home visits/live patients only if able in 2021
  • Virtual visits/Telehealth
  • Virtual cases

Primary Care Pathway program

Winter ’20

  • Students interact with live patients via shadowing
  • Virtual visits via Telehealth 

Medical Mandarin

 

  • Currently not using SPs but requested SPs for 2020
  • Either consider RSPs or postpone SPs until 2021

Medical SPs = upper year medical students, residents, fellows; RSPs = Remote Standardized Patients

MS 2 Curricula

Course

Dates

Pre-COVID Curriculum

COVID-Impacted Curriculum 

Adult ICM

  • Hx
  • PE

Intro to Ultrasound

8/20 – 12/20

  • SPs from PSOM SP program
  • RSPs from PSOM SP program for Hx sessions
  • Medical SPs for PE sessions
  • Medical SPs or online web app for ultrasound session

Pediatric ICM

10/20 – 12/20

  • CHOP inpatients in-person
  • CHOP inpatients in-person or via telehealth

Cardiology 

  • ultrasound 

8/20, 9/20

  • SPs from PSOM SP program
  • Medical SPs 
  • Web-based/virtual app

Differential Diagnosis

12/20

  • SPs from PSOM SP program
  • Children (for peds portion)
  • Medical SPs
  • Web-based/virtual app

Pre-Clerkship Week

12/20

  • SPs from PSOM SP program
  • Medical SPs

LEAPP

Fall ‘20

  • Home visits/live patient visits
  • Virtual visits/Telehealth
  • Virtual cases

Primary Care Pathways Program

Fall ‘20

  • Students interact with live patients via shadowing
  • Students interact with patients virtually via Telehealth visits

Medical Mandarin

 

  • Currently not using SPs but requested SPs for 2020
  • Either consider RSPs or postpone SPs until 2021

Medical SPs = upper year medical students, residents, fellows; RSPs = Remote Standardized Patients

 

VII. Summary of Para-curricular Activities involving Direct Patient Care

Volunteer Experience

Activity

Pre-COVID Curriculum

COVID-Impacted Curriculum 

Student-led Community Clinics

Activities listed here

  • MS1 – MS4 volunteers see patients in community clinics
  • Each program must develop a safety plan for student re-entry
  • Plans must be developed with faculty advisors and approved by the Assistant Dean for Community Engagement

Education and Patient Outreach Opportunities

Activities listed here

 

  • MS1 – MS4 volunteers perform community outreach
  • Each program must develop a safety plan for student re-entry
  • Virtual opportunities will be prioritized
  • In person plans must be developed with faculty advisors and approved by the Assistant Dean for Community Engagement

High School Student Mentoring 

Activities listed here

 

  • MS1 – MS4 volunteers perform community outreach
  • Each program must develop a safety plan for student re-entry
  • Mentoring may be accomplished via remote methods when possible 
  • In person plans must be developed with faculty advisors and approved by the Assistant Dean for Community Engagement

Hospital and Clinic-based Volunteer Activities

Multiple activities available

  • MS1 – MS4 students volunteer in hospital with approval from faculty mentors
  • MS3 and MS4 prioritized
  • Email Dr. Cindy Christian and Dr. Nadia Bennett for approval
  • Approval will be granted on a case by case basis using the guiding principles outlined above

Shadowing 

Multiple activities available 

  • Students allowed to shadow health care providers in the clinical setting without any major restrictions 
  • Students are not permitted to shadow health care providers in the clinical setting at this time to limit overcrowding

 

VIII. Summary of Research Activities Involving the Clinical Environment

Research Activity

Pre-COVID Curriculum

COVID-Impacted Curriculum 

Non-clinical research

  • Follow guidelines outlined by BGS and by your research team
  • Follow guidelines outlined by BGS and by your research team

Clinical research not involving direct patient contact or interaction in the clinical setting

  • Follow guidelines outlined by BGS and by your research team
  • Follow guidelines outlined by BGS and by your research team

Clinical research involving direct patient contact or interaction in the clinical setting

  • Follow guidelines outlined by BGS and by your research team
  • Complete the form found online here
  • Approval will be granted if you are able to meet criteria outlined in the form