The rapid expansion of remote consulting in primary care, after the pandemic struck in the UK in 2020, changed the experience of medical education, both for the GP tutors and for medical students in primary care placements. What can be done to protect and enhance the educational value of primary care placements in the post-COVID era, given the expanded role of telephone triage, remote and e-consulting, virtual home visits and online meetings?
To find out, Dr Richard Darnton, Director of the General Practice Education Group at the University of Cambridge, and colleagues asked students and GP supervisors to describe their experiences during the pandemic in November 2020, before the UK vaccination programme began.
Following a five-week clerkship (or placement) for final year medical students in the East of England, the team interviewed 10 students and 11 supervising general practitioners from 16 different GP practices. The goal was to understand what they thought about the nature and value of learning medicine in primary care now compared with prior to the pandemic.
The interviews revealed that students generally undertook a combination of telephone-and face-to-face consultations, except in a minority of practices where students were not exposed to remote consulting. Video consultations were rare and mainly occurred in a single practice that had developed a protocol for promoting that method as the primary method of consultation. Home visits had also become rare, with most students experiencing only one or two during their six-week placements. The practices were running their meetings and informal conversations both remotely and face to face.
Students were sometimes gathering information from patients quite independently of their supervisors in both telephone and face-to-face consultations, just as they had before the pandemic. But telephone consultations had a tendency to engender a greater degree of supervisor involvement due to their concerns around patient experience or the risks involved in students using the telephone to assess the patient.
In terms of patient contact, supervisors and students interviewed for the study tended to agree that while less patient contact was enabled, the educational value of each contact was higher. Supervisors reported screening out administrative cases and trying deliberately to provide a case mix that would provide a range of learning opportunities. The widespread use of triaging systems in primary care since COVID-19 enabled this approach and also offered students more opportunity to prepare before seeing each patient. One student said:
“I saw fewer face-to-face patients, but I think they tended to be more interesting patients from a learning perspective.” Student 8
- The triaging systems implemented in primary care during the pandemic are a powerful tool for selecting the most educationally valuable patient problems for student consultations;
- Knowledge about the sociocultural context of illness may sometimes be acquired via video consultations;
- Student video consultations appeared to be more successful where a “video-first” approach was used (rather than telephone converting to video mid-consultation);
- While it remains important for students to undertake face-to-face consultations in primary care, student telephone consultations in the post-COVID era appear to engender specific educational benefits;
- Supervision of student telephone consultations requires careful attention to ensuring students still get sufficient responsibility. Undertaking unobserved consultations and delivering the explanation and planning part of consultation are key to this.
Read the article
Richard Darnton, Maaz Khan, Xiu Sheng Tan, Mark Jenkins, Primary Care Placements in The Post-COVID Era: a qualitative evaluation of a final year undergraduate clerkship. Medical Teacher 3 December 2021
Contact: Lucy Lloyd, Communications, Primary Care Unit
Image: Dr Jon Ferdinand for Primary Care Unit