Faculty of Medicine Schools develop new approaches for clinical training during coronavirus pandemic

When the COVID-19 pandemic began making its way through Canada in March, life as we knew it was quickly thrown awry. While educational institutions closed their campuses to limit transmission of the novel coronavirus, health care professionals from all disciplines shifted their full focus to front-line efforts to effectively do battle.

An important consequence was the sudden halt of clinical education for students in the health professions, a key component in preparing the next generation for graduation and ultimately for delivery of patient care. While the traditional means to educate students was temporarily no longer available, the health profession schools at McGill University’s Faculty of Medicine, sprang into action to identify innovative, alternative means for students to gain clinical experience, both now and in the coming months, despite the ongoing global pandemic.

Expanded medical student course to meet pressing COVID-19 needs

Clinical placements, or clerkships, are an integral component throughout medical school, allowing students to gain firsthand exposure to patient care. With these rotations no longer available, McGill medical students sought to contribute to efforts to fight the COVID-19 pandemic. The  Undergraduate Medical Education (UGME) team quickly began looking at ways that would allow students to make an impact, while keeping the students and others safe and respecting public health directives.

Within a week, UGME announced that all medical students could register for the ELEC 200 Global and Public Health Pre-Clerkship Elective. The non-credit elective, usually open only to first- and second-year students, allows medical students to support local community and public health projectsMore than 206 students stepped up, supporting over 12 different projects at health care institutions like the Montreal Children’s Hospital and CLSCs and at community organizations such as Head and Hands.

Projects ranged from phoning Emergency Room patients to provide their lab results, to conducting geriatric assessments and counselling, to staffing a COVID-19 hotline for adolescents. At a time when hospitals were rushing to prepare for the onset of the pandemic, McGill medical students were able to provide needed support, while at the same time gaining valuable health care experience.

A new way of teaching at the Ingram School of Nursing

Clinical courses offered at McGill’s Ingram School of Nursing (ISoN) focus on enhancing clinical skills, assessment capabilities, clinical reasoning, and integration into the clinical milieu. To meet these professional nursing practice objectives, teaching laboratory, inquiry-based and courses requiring placements in clinical areas are offered.

As a result of the pandemic, the remainder of winter 2020 session courses were not only delivered remotely at the ISoN, but also modified to be delivered asynchronously. This allowed students to participate at a time of their choosing, given some may be working, have family responsibilities, or be living in a different time zone.

In the Bachelor of Nursing (Integrated) program, an initiative referred to as “Reconnaissance des aquis” has been introduced to recognize current on-the-job learning.  This approach recognizes competencies that students have already acquired and then guides students in achieving the remainder of the competencies required to complete the academic program. This approach highlights the theoretical foundations of clinical nursing care as well as developing critical thinking in students.

McGill is the first and only English Canadian University to offer wound care as part of its curriculum in both the undergraduate and graduate programs. While the course is usually offered in conjunction with laboratory skills courses and with students’ first medical-surgical clinical placement – where they have the opportunity to review and apply some fundamental skills related to wound care in a clinical setting – as a result of the pandemic, it was offered to students remotely.

Going remote to build clinical skills in Physical and Occupational Therapy

At McGill’s School of Physical & Occupational Therapy, both the Occupational Therapy program and the Physical Therapy program have implemented innovative approaches to provide the first clinical course to students transitioning into the professional Master’s component of training.  While the School’s university-based courses were quickly adapted to remote learning, clinical education, in partnership with multiple community, academic and institutional partners, required major re-thinking to meet accreditation and regulatory standards, while minimizing direct patient contact and maintaining physical distancing.

Professor Caroline Storr and her team (Karen Falcicchio and Valerie Watters) developed a hybrid clinical placement course alternative focusing on three practice themes of rehabilitation practice: Tele-health and remote service, Knowledge Translation (educational tools) and Emerging Roles for Occupational Therapists in Quebec. It can be argued that a silver lining exists due to COVID-19: the enabling of a complete cohort of 70 Occupational Therapy students to practice social accountability and create health solutions for diverse groups, including patients, such as those at long-term care centres (CHSLDs), and stakeholders including the Alzheimer’s Society of Canada and the Cree Board of Health and Social Services of James Bay.

Professor Adriana Venturini and her Physical Therapy clinical education team (Crystal Garnett and Martha Visintin) were able to quickly organize tele-health placements and training for students beginning their clinical training at a large physiotherapy clinic franchise.  Moving forward, they plan to leverage this experience to develop future tele-rehabilitation placements in McGill-affiliated clinics in both the public and private sectors.

The feedback from Occupational Therapy students has been excellent; one student’s comments, “I wanted to thank you for all of your work and considerations regarding this ‘stage.’ I have greatly enjoyed the experience so far and I am loving the experience of communicating and collaborating with my new colleagues.”

Speech-language pathology assessment and therapy goes virtual

Finally, in terms of clinical training at the School of Communication Sciences and Disorders (SCSD), the in-house teaching clinic was outfitted with new equipment, enabling them to deliver services completely via tele-health this summer and in the future.

Clients, students and supervisors all connect remotely from their own homes. In this way, Speech-language pathology supervisors can continue to offer services to clients and clinical placements to students, all while respecting public health directives to maintain physical distancing. This is particularly important given that one of the main populations typically served by the SCSD’s clinic is older adults who are at greater risk in terms of leaving their homes, so it is additionally valuable to provide them opportunities to connect with others. Lauren Tittley is supervising the students who are providing language therapy in this context. Professor Noémie Auclair Ouellet has designed a research program to assess the progress achieved by older adults when treated in this unique clinic by SCSD students.

Under the supervision of Mariska Burger, the SCSD is also continuing to allow students opportunities to provide speech and language therapy services via tele-health to preschoolers at the McGill daycare. Sophie Vaillancourt is helping in the supervision of students who are providing tele-health services to school aged children from Kahnawake allowing at-risk youth from an indigenous community to continue to receive needed S-LP services while their school is closed. Professor Susan Rvachew is developing a fourth tele-health station so that students can provide an experimental intervention to school aged children with complex speech sound disorders. This new mode of delivery is well suited to Canada where clients are often far away from centralized health care services. The pandemic has been a stimulus to provide more training to student speech-language pathologists in this efficient way of helping people with communication difficulties.

Stay tuned in the coming weeks for additional stories highlighting teaching innovations across the Faculty of Medicine.

June 11, 2020