Dr Richard Darnton discusses his latest research, published in Medical Teacher, January 2023.
UK medical students spend much of their training based in primary care centres undertaking consultations with patients under the watchful eye of a supervising doctor. The advent of COVID-19 triggered a huge increase in the proportion of doctor-patient consultations occurring remotely (via video or telephone).
For the first time, medical students started doing telephone and video consultation with patients, sometimes even from the medical student’s own home. Now the pandemic has receded, questions remain about the future of remote consulting for students and whether it can help address medical education problems, like the lack of consulting space in many health centres.
Our research paper looks at the degree to which medical student involvement in remote consulting has become mainstream … and how supervising doctors feel about this.
We surveyed a population of primary care centres during April 2022 and had an excellent 96% response rate. We found that:
Remote consultations formed a significant proportion of medical student activity (and predominantly these occurred by telephone rather than video). However, the relative proportions of medical student consultations undertaken face to face and using the telephone varied considerably between centres.
Confidence supervising medical student consultations was similar for remote and face to face consultations, IF the student was located at the healthcare facility. However, a significant proportion of clinical supervisors lacked confidence supervising medical students consulting from home and a number of reasons for this were elicited.
Although medical students consulting from home is no panacea, it does offer some solutions with regards to lack of premises space.
Our findings suggest that medical student involvement in remote consultations is no longer rare or novel … unless the student happens to be based at home. Our paper uncovers why some doctors may feel reluctant to supervise medical students consulting from home and suggests strategies for increasing educator confidence and engagement with this innovation.
Dr Richard Darnton, Director of Studies in General Practice and Director of the General Practice Education Group
More about this research
The team’s data, from this survey of 115 GP teaching practices in the East of England, showed that:
- 48% of responding practices reported that their students had carried out some video consulting during the last year, to a small extent in most cases;
- 18% of practices had supervised a medical student who had undertaken remote consultations from their own home;
- 90% of practices had some confidence supervising a medical student undertaking a telephone or video consultation from their surgery;
- In contrast, 42% had some confidence supervising students doing telephone consultations from their own home and 36% had some confidence supervising students conducting video consultations from their homes.
The team’s analysis of comments made by respondents identified reasons why some doctors in the study had worries about supervising medical students consulting from home. Broadly speaking, this subgroup had concerns that the innovation might be inconsistent with aspects of safety, simplicity and/or quality.
Concerns about safety surrounded perceived risks to patients and to the GP practice, with one GP asking: “…are they aware and able to comply with confidentiality, living in their student accommodation?”
Some GPs also worried about the potential for added complexity created by lack of familiarity with the method and the additional IT required.
Finally, some respondents were mindful of enabling a 3-way dialogue and meeting perceived student expectations.
The research team suggested practical steps to address these concerns, such as presenting ‘consulting from home’ as an additional option, rather than a replacement for face to face consulting. They also acknowledge that some supervisors will feel they need face to face familiarity with the student before they can attach trust to the student in the ‘consulting from home’ context.
Dr Darnton said: “According to Rogers’ diffusion of innovations theory, there will always be early and late adopters of a relatively novel teaching method. Our qualitative analysis has identified the perspective of later adopters of medical students consulting from home. Applying Rogers’ theory to these findings has enabled us to provide many practical suggestions in the paper for widening the uptake of this teaching method amongst teaching faculty.”
Read the research
(2023) Medical students remote consulting from home and from the health centre: A survey of prevalence and supervisor perspectives.
Medical Teacher, DOI: 10.1080/0142159X.2022.2158068