When it became clear last spring that the pandemic would prevent students from working on their HOP programs in person for some time, the organization’s student leaders began brainstorming alternative options. HOP co-chairs Benjamin Hutchison and Rohan Sehgal, both second-year medical students, began discussing how they might offer in-person services online.

“At that point, our executive board was worried the most for these individuals who rely on our health services, but weren’t able to access them anymore,” Sehgal said.

Sehgal and Hutchison collaborated with student leaders from HOP and from other student-run Pennsylvania clinics, and worked closely with faculty advisors Annette Gadegbeku, MD, an associate professor in the Department of Family, Community & Preventive Medicine, and assistant dean of community health within the Office of Diversity, Equity & Inclusion, and Steven Rosenzweig, MD, director of the Office of Community Engagement and a professor in the Department of Emergency Medicine. Through these conversations, HOP leaders determined protocols for COVID-safe community outreach and education, as well as for providing high-quality, HIPAA-compliant teleclinic health care.

“We’ve had to learn a lot on the fly,” Hutchison said.

He said that HOP leaders have been able to adapt about 50 percent of HOP’s activities to virtual operations over the last several months. A couple of clinics have reopened to offer virtual appointments, and various projects focused on childhood health and wellness, and on community education, have likewise moved to virtual formats.

HOP projects active online include, but aren’t limited to, student-led stress reduction, yoga classes, and tutoring for elementary school students experiencing homelessness. Sehgal said an unexpected silver lining of remote-only work was the opportunity to expand students’ ability to run community education on smoking cessation, and to teach overdose reversal to other medical students.

Sehgal said new HOP projects have emerged during the pandemic, as well; student volunteers coordinate produce drop-offs for free clinic patients facing food insecurity, and provide health education to program participants at The Arc of Philadelphia, where students ran a free clinic for people with intellectual and developmental disabilities prior to the pandemic. The latter initiative is not only a collaboration with leadership at The Arc, but also with other Philadelphia-area medical students.

Highlighting the year’s challenges, HOP students will lead presentations on a number of topics at the national virtual Society of Student Run Free Clinics Annual Conference in March.

“Normally you’d submit one paper or abstract per student-run free clinic,” Sehgal explained. “But we’re going to have eight folks presenting on everything from our response to COVID-19, to telehealth, and all kinds of other things we have going on.”

He said that students were happy to wear multiple layers of personal protective equipment (PPE) for a community distribution of the overdose reversal drug Narcan at Philadelphia’s Day of Dignity event in October. HOP students know that preventing the spread of COVID-19 is a crucial part of providing high-quality resources to the community.

It still isn’t clear when HOP students will return more widely to in-person work in clinics and in the community, but now there are protocols in place to do so safely once the opportunities arise.

“The new leaders have been given all the keys to a safe reopening,” Sehgal said. “They just need to put them in the door and enter.”

Second-year student leaders will leave their positions in 2021, but have learned from the unprecedented demands of the pandemic. New HOP leaders will inherit clear guidelines for helping underserved community members with COVID-19 safety in mind: prioritizing PPE, sanitization and social distancing whenever possible.

For the foreseeable future, HOP students will continue to serve Philadelphians virtually. Among the student-run clinics that reopened for telehealth was Venkat’s, where first- and second-year student volunteers join physicians and patients on Zoom calls, then start off the appointment as they would in an office.

Prior to the pandemic, a patient would arrive at a HOP clinic with a health concern and be greeted by a first-year medical student who would perform a physical exam, take the patient’s medical history and reason for their visit, and present all the information to a supervising physician. Students’ first patient interactions are with HOP patients, and Sehgal, Venkat and Hutchinson said it is an invaluable hands-on learning experience.

“A lot of what we do in M1 and M2 can be academic-based; it’s a lot of reading. A lot of what we talk about is in theory, ‘Oh, here are the social determinants of health,’” Sehgal said. “It’s not until you actually speak with a patient that you learn to translate the skills you’ve been taught into an actual interaction.”

As a first-year medical student, Sehgal hadn’t expected patients to share their whole medical history when he asked the question that he had been taught to lead with, “What brings you in today?”

“That real-world experience was really impactful for me, because now when I’m taught ‘Here are the questions you should ask,’ I know there’s more to a patient interaction than just a script,” Sehgal said. “There’s a whole background that has brought an individual to seek care, and that sometimes gets lost in medical curriculum, unless you talk with patients.”

Venkat was pleasantly surprised to see that HOP’s student-patient interactions hadn’t become any less meaningful when they were conducted virtually.

“My site doesn’t even have video, just audio, so we don’t have the added benefit of seeing the person to whom we’re providing care,” she said. “They have to describe their pain or their symptoms to us. It’s really interesting – you’d be amazed how much you can pick up just from that.”

Venkat said the major difference she has noticed between working with patients this year and last is the role of body language. On the phone, Venkat cannot smile to make a patient feel comfortable or gesture to convey information, but has adjusted reactions to the nature of the conversations.

“You’re still making a connection and forming a relationship with the patient, even if it may seem harder to do,” she said. “Something that wasn’t really hindered by Zoom was that we do get the same people checking in each week, and they recognize my voice. We can pick up from where we were a couple of weeks ago.”