Is Now the Time for a Public Health Clinical Elective?

The COVID-19 pandemic has upended didactic and clinical education for PA faculty and students. But the public health nature of this crisis does present unique opportunities for our clinical year students, through innovative elective rotations helping their local communities respond to COVID-19. 

Last month, PAEA and several U.S. health professions education associations recommended “a clinical pause,” pulling students from rotations to ensure their safety and allow hospitals to focus their efforts to prepare for the wave of COVID-19 patients. During the clinical pause, health profession education associations have been working interprofessionally to design learning experiences for medical, PA, nursing, mental health and public health students to work and learn together to contribute meaningfully to our response to the COVID-19 pandemic. With state and local public health coordination, opportunities are emerging for health professions students to be deployed to provide home visits, testing, monitoring, surveillance, case reporting and tracking across the country. The University of Utah and Rutgers PA programs have shared with PAEA an overview of how they have coordinated with local health departments to provide students an opportunity to be part of the local COVID-19 response.

Rutgers School of Health Professions 

Rutgers PA students are involved in an important clinical study tracing the spread and consequences of SARS-CoV-2 infection in health care workers and a comparison group of non-healthcare workers. The study, sponsored by the New Jersey Alliance for Clinical and Translational Science (NJACTS) aims to enroll about 700 subjects. This work will help Rutgers researchers and PA students understand risk and transmission and may lead to an immunological assay that could help determine whether an individual has COVID-19 immunity. This could allow health systems to make important decisions about which providers to place on the front lines of the COVID-19 pandemic and when quarantine related to potential exposure is necessary. Rutgers students are also gaining experience using REDCap (Research Electronic Data Capture), a secure, web-based application for building and managing online surveys and databases.

Rutgers PA student involvement includes:

• 20 third-year PA students participating; most will earn credit towards an elective rotation
• Being assigned for about 20 hours per week 
• Assisting patients and verifying paperwork and consents, performing phlebotomies, and collecting saliva and oropharyngeal swab samples 

Program Director Matthew McQuillan noted that “this unique opportunity was met with enthusiasm, and almost half of the graduating class is participating. Many are able to earn elective credit for a clinical rotation, although many chose to participate simply because they realized they could be of service.” A NJACTS study coordinator remarked that “the PA students are awesome; not only skilled, but enthusiastic and picking up the whole process very quickly — they’re all REDCap experts now.” 

University of Utah PA Program (UPAP) 

With two campuses and 60 students (Salt Lake City 44, St. George 16) four hours apart, UPAP clinical-year students are participating in two different experiences: In Salt Lake City, students are teamed with the Utah Coronavirus Information Line, run by the Utah Poison Control Center (UPCC), and in St. George, students work with the Utah Department of Health (UDOH). Both systems were overwhelmed with calls about COVID-19 and reached out to the university for help. The elective clinical rotations were set up within three weeks of the announcement of the clinical training pause. The interprofessional student teams of PA, pharmacy, nurse practitioner, and public health students contribute to a scope of work that includes:

• Assessing patients for signs and symptoms of COVID-19 and triaging them  
• Providing risk assessments for asymptomatic individuals exposed to the virus 
• Educating callers on symptoms, prevention, incubation period, disinfecting, controversial therapies, and comorbidities 
• Learning about other barriers to patients in a pandemic – access to care for certain populations, and the economic and health system impacts  
• Learning to adapt to changing information and public health recommendations in a pandemic 
• Practicing patient communication 
• Patient/client education using current sources, primarily via templates from the World Health Organization, Centers for Disease Control and Prevention, and the Utah Department of Health 

In Utah, the average number of patient encounter calls generated is 374 per day (range 170-499) with peak volume of 1,200 from a surge day early on. The UPCC medical director has developed a guideline for the information line, which is regularly updated as information evolves. Each call is documented and recorded in an electronic medical record, and every call is recorded. All documentation is reviewed by a senior UPCC staff member. Students in St. George work simultaneously with UDOH employees who monitor and support the students’ responses. Said one Salt Lake City student: “I’m grateful for the opportunity to be serving a helpful purpose and be on the front lines of helping and learning in this crisis in a safe way. … I am learning a lot about testing criteria, UDOH/CDC guidelines, and up-to-date information regarding any changes to COVID-related policies and safety precautions. I am also learning what people in the community are commonly concerned about and how to offer reassurance.”

These are just two examples of innovations in clinical training that are being implemented across the country to address interruptions in scheduled clinical rotations, while capitalizing on the unique opportunity to engage PA students in the response to a global health crisis and provide unprecedented experience in epidemiology, public health systems, and clinical care. If you have other examples, please share them with PAEA at communications@PAEAonline.org.