e-ICU: Saving fourth-year students’ required ICU rotations
Ashlyn Reiser, MD '20, was eager for Match Day and ready to close out her required rotations with four weeks in an intensive care unit (ICU) when COVID-19 struck.
“My ICU rotation was my last requirement,” she said. “I was very worried. I matched into ophthalmology, but I still need to do a transitional year and it will require time in the ICU. I was afraid my medical education would be incomplete.”
Dr. Reiser and her classmates who still required ICU rotations didn’t have long to fret.
Peggy Shoemaker, MD, assistant chair of internal medicine and assistant professor of medicine, along with Cassiopia (Cass) Lippold, MD, a critical care fellow at Geisinger, devised a solution in less than a week. Together, they created a rotation in the e-ICU, giving fourth-year students a virtual experience that included direct patient interaction.
“I can’t say enough about how impressed I was that Dr. Shoemaker came up with a solution so quickly,” Dr. Reiser said. “But I admit, I was a little skeptical about how theywere going to pull it off.”
In the end, Dr. Reiser said her four weeks in the e-ICU rivaled — and in some ways, exceeded — physically being in the ICU.
The cardiac ICU in Danville is equipped with a camera and screen typically used by hospital staff for clinical care purposes. This technology was repurposed to allow students to “enter” the patient room remotely, interact with the patient to conduct a history, and then direct a bedside fellow or resident to obtain a physical exam under the students’ direction.
Dr. Lippold said she and her other colleagues gently prompted students if they missed a step by asking questions like, “Are you sure there isn’t anything else you’d like me to do?” Students were granted permission to access “their” patients’ electronic health records in a special platform that allows student practice of note and order entry, as well as following the patient’s entire hospital course. Students and residents found that most patients were eager to help with the lessons.
“Dr. Shoemaker was right there with us the whole time,” Dr. Reiser said. “She would send us our schedules for the week. Then we could access Epic to prepare to follow patients, present patients and do handoffs, just as I will in residency. In some ways, I think I learned more than I would have if I had done a normal ICU rotation. We had protected time with the residents. During that time, they weren’t pulled in a dozen other directions. They spent so much time on differing topics, like COVID-19 and mechanical ventilation. I feel well prepared for my residency.”
Although participating in the e-ICU placed extra demand on residents’ and fellows’ time, in addition to Dr. Lippold, six other house staff taught medical students rotating in the e-ICU:
- Alejandra Garcia-Fernandez, MD, critical care fellow
- Alexis MacDonald, MD, critical care fellow
- Dan Leopone, MD, critical care fellow
- Brandon Nuckles, MD, general surgery resident
- John Samies, DO, internal medicine resident
- Gregory Stoner, DO, emergency medicine resident
Read TIME's "How U.S. Medical Schools Are Training a Post-Pandemic Generation of Doctors."
Footage captured in August 2020