By Lillian Khan, BS, 2nd Year Entry Level Master of Science in Nursing (ELMSN) student at Samuel Merritt University(SMU); Amin Azzam, MD, MA, Simulation Educator and Professor at Samuel Merritt University; Teresa Gwin, EdD, RN, GNP, Associate Professor, and Assistant Director, Family Nurse Practitioner Program, College of Nursing, Samuel Merritt University; Michael J. Negrete, PharmD, Assistant Academic Vice President, Samuel Merritt University; Amy Hester-Anderson, BA, Special Projects Coordinator, Office of Academic Affairs
When the COVID pandemic made face-to-face encounters impossible, Samuel Merritt University (SMU) began offering a virtual, simulation-based version of the Interprofessional Student Hotspotting Learning Collaborative curriculum. This format allowed us to continue delivering this important curriculum to the next group of healthcare students during the fall 2020 semester, while stay-at-home orders were in effect. We got great feedback from students and faculty on the virtual, simulation-based patient encounters, and hope to encourage others to take on this versatile format during the COVID pandemic and beyond.
Student Hotspotting in a pandemic
SMU joined The National Center for Complex Health and Social Needs in 2017 as one of the program’s four Hotspotting Hubs, offering the Interprofessional Student Hotspotting Learning Collaborative (Student Hotspotting) curriculum to colleges and universities in the United States’ western region. Traditionally, the curriculum pairs student teams with real community members who are struggling with medical, social, and behavioral needs and supports them over the course of a six-month program. This approach was intended to introduce and educate the next generation of healthcare professionals on delivering patient-centered care to a growing population that requires a more intense approach to support their complex health conditions —a necessary skill set to prepare students for their future careers.
Amidst the COVID pandemic, offering the Student Hotspotting curriculum in its traditional format proved quite a challenge during the 2019-2020 academic year. Though patient-student encounters are at the core of the curriculum for Student Hotspotting, it was not feasible to offer a safe avenue for student-patient meetings during the pandemic. With limited in-person social interactions, the SMU Student Hotspotting staff had to find a way to offer the curriculum to accommodate 67 students across eight different universities, spanning California and Nevada, covering ten different health professions. With the help of SMU’s well-established Health Sciences Simulation Center (HSSC), SMU Hotspotting program leadership decided to develop high-fidelity, virtual, simulation-based longitudinal client encounters to replace the face-to-face client sessions for the 2020-2021 academic year.
Shifting to virtual, simulated patient encounters
We incorporated standardized patient (SP) actors playing a client with complex health and social needs. The format described here was able to accommodate over 90 students and faculty from SMU; California Northstate University (CNSU); John F. Kennedy University (JFKU); San Francisco State University (SFSU); San Jose State University (SJSU); University of California, Berkeley (UCB); University of California, San Francisco (UCSF); and the University of Nevada, Reno (UNR). The healthcare disciplines represented by the student participants included: medicine, physician assistant, nursing, occupational therapy, pharmacy, physical therapy, podiatry, psychology, public health, and social work.
To support the large cohort and maximize discussion, the class was distributed across three separate weeknight sessions. Students were allowed to choose between the three weeknights which best fit their schedule but then required to stay on that weeknight throughout the semester. This resulted in class sizes of 20-30 students per night. The students were then further split into interprofessional student sub-groups of four-eight with representations across healthcare disciplines. All sub-groups were allowed time to brief before the simulated patient encounter to plan out their potential session. From these sub-groups, an action learner group was chosen by lead faculty randomly to interact with an SP each night while the rest of the class acted as observer learners. Additional faculty acted as facilitators during content and debriefing discussions.
The course content was divided into six longitudinal, episodic scenes over the course of four months with group sessions every two weeks. The pre-scripted content of each SP session related to the course content of the week before. SPs took each meeting in their private homes and were assigned a specific evening session group with whom they remained throughout the four months. In each of the three nights, the three different SPs played the same character/patient with complex medical, social, and behavioral health issues (including multiple chronic medical conditions, frequent hospitalizations, fragile housing, substance use disorder, and limited social support network). In between sessions, students were given a portion of the Student Hotspotting curriculum as a “skills content lab” to learn, review, and interact with before each subsequent virtual patient-encounter.
Student and faculty feedback
After the course, we used anecdotal notes from program leadership, debriefing notes from faculty, and surveys and evaluations from students to evaluate the impact of integrating simulation-education into the Student Hotspotting course.
The course received nothing but positive feedback and support from faculty and students. Both enjoyed the content and expressed that the course was valuable in teaching students how to work with patients who have complex medical and social needs. Many of the students declared that this was their first exposure to practicing complex patient encounters and being a member of an interprofessional team. They also expressed a need for more courses that address the delivery of complex care to support patients.
Additionally, the faculty appreciated the virtual simulation format stating it added certain benefits and convenience over the traditional format. The main benefit was the ability to include a larger number of students and partner universities when real clients from the community are hard to find or are unwilling to participate in the program.
Overall, as a substitute for face-to-face interaction with real patients, this virtual, simulation-based format of the Student Hotspotting curriculum discussed here has allowed healthcare students to engage with the traditional curriculum and exercise their patient care delivery skills in a new, effective way during the pandemic with restricted social contact. Although nothing will completely take the place of interactions with real patients, this option offers many benefits. It overcomes many hurdles presented by the current pandemic and possible schedule coordination and client participation seen in the traditional format.
If not used as a substitute, this version of the course may be offered as a great prerequisite or supplement in preparing students to work with individuals with complex needs before working with real clients. This format also offers endless possibilities for disseminating the National Center’s curriculum for complex care training to new hubs, faculties, and universities in an interactive, virtual format. If other hubs, or other institutions doing similar interprofessional training programs, have a simulation and standardized patient program in place, we highly encourage trying out this format to enrich the current Student Hotspotting curriculum or to act as an alternative during the pandemic