The sudden demand for telehealth to replace in-person interactions during the COVID-19 pandemic has underlined a corresponding need in U.S. medical education: training in health care technology.

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Content related to health systems science—an understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery—has become more frequent on the United States Medical Licensing Examination (USMLE). The National Board of Medical Examiners includes the topics in its USMLE Content Outline and offers a dedicated health systems science subject examination.

To help medical students, the AMA Accelerating Change in Medical Education Consortium has collaborated with the “InsideTheBoards” podcast to create a health systems science (HSS) podcast series. Each episode of the HSS series offers on-the-go learning by breaking down practice exam questions with expert guests.

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A recent episode featured a conversation with a physician mentor and a medical student at Johns Hopkins who took the opportunity thrust upon them by the COVID-19 pandemic to create a virtual clinical elective that not only expanded access to neurological care but also broadened how neurologists look at their specialty.

“As a clerkship director, I was just kind of wondering, how and when are we going to restart?” said Rachel Salas, MD, associate professor of neurology at Johns Hopkins Medicine, noting that she knew telehealth would be an essential element, although it wasn’t something the clerkship had ever employed. “We said: Why don't we come up with this elective that we can do on a smaller scale? And what we will do is use our experience from that elective to inform us when we restart the clerkship. So we will kind of be ahead of the game.”

The elective—a two-week course called “Virtual Patient Rounds in Neurology”—was first offered in April and then again in May.

“What we wanted to achieve with this particular elective is offering students away to learn telemedicine in a virtual hands-on [situation] while also providing a neurology lecture series in a more broad manner since clerkships were canceled all over the country, all over the world,” said Kori Porosnicu Rodriguez, a fourth-year medical student and Osler apprentice—a designated peer advisor for the neurology clerkship—at Johns Hopkins University School of Medicine.

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The virtual rounds featured teams of two or three medical students, one Osler apprentice to serve as a peer mentor and one faculty member, who rounded together twice a week online and later contacted patients by Zoom or telephone.

“This was particularly interesting for me since I hadn't had any telemedicine experience,” Rodriguez said, adding that one of the biggest challenges was translating the neurological exam into a virtual setting. “It's not as easy as just turning on the camera and kind of trying to describe everything. It took a lot of careful planning.”

It turns out, though, that neurology is particularly well-suited to telemedicine.

“A lot of our exam really starts from the minute the patient walks into the room—or doesn't walk into the room,” Dr. Salas said. “The way they talk, the words they choose—you know, it really is a visual examination from the get-go.”

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