Rodriguez Vanessa, Rivera Veronica, Goldhirsch Suzanne, Ramaswamy Ravishankar
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Gerontol Geriatr Educ. 2022 Oct-Dec;43(4):584-589. doi: 10.1080/02701960.2021.1968386. Epub 2021 Sep 5.
The Medicare Annual Wellness visit (AWV) was mandated as a fully covered benefit for older adults to enhance preventive care and improve healthcare outcomes. Although the benefit of conducting AWV is proven, its adoption in primary care is far from universal. The COVID-19 pandemic affected medical education and clinical care in unprecedented ways. Telehealth became a prominent way of delivering healthcare. Older adults, being significantly affected by the pandemic-related mortality and morbidity, were less likely to engage in preventive care with their healthcare providers. Amidst this considerable shift, we conceptualized a clinical experience for third-year medical students during their Ambulatory Care - Geriatrics clerkship that involved a telehealth interaction with an older adult to review AWV components, followed by an in-person office visit with the geriatrician preceptor. Post-session survey data highlighted the beneficial effect on student learning about older adult health maintenance, immunizations and geriatric syndrome assessment. It also facilitated self-directed learning and increased student-patient rapport. Preceptors appreciated the additional elements of care identified by the telehealth call that would otherwise not have been addressed in a time-limited office visit. This hybrid clinical experience reduced crowding in ambulatory clinical space during the COVID-19 pandemic, yet enhanced learning for students in geriatrics preventive care.
医疗保险年度健康检查(AWV)被规定为老年人的一项全额覆盖福利,以加强预防保健并改善医疗保健结果。尽管进行AWV的益处已得到证实,但其在初级保健中的采用情况远未普及。新冠疫情以前所未有的方式影响了医学教育和临床护理。远程医疗成为提供医疗保健的一种重要方式。老年人受到与疫情相关的死亡率和发病率的显著影响,与医疗服务提供者进行预防保健的可能性较小。在这一巨大转变中,我们为三年级医学生在其门诊护理 - 老年医学实习期间构思了一种临床体验,其中包括与一位老年人进行远程医疗互动以回顾AWV的组成部分,随后与老年医学带教老师进行面对面的门诊就诊。课后调查数据突出了对学生了解老年人健康维护、免疫接种和老年综合征评估的有益影响。它还促进了自主学习并增强了学生与患者之间的融洽关系。带教老师赞赏了远程医疗电话中发现的额外护理要素,否则这些要素在限时门诊就诊中不会被提及。这种混合临床体验在新冠疫情期间减少了门诊临床空间的拥挤,同时增强了学生在老年病预防保健方面的学习。