Research by the University of Cambridge shows how medical students can engage in remote consultations and keep learning directly from patients even during the pandemic.
Medical teachers can enable their students to successfully gain clinical experience even during lockdown periods, via supervised remote consultations with patients, according to a study carried out in June 2020 during the UK lockdown. The study, based on in-depth interviews with students and supervisors who took part in a pilot, provides insight into the benefits and challenges of the model for students and their supervisors.
Medical teachers at the General Practice Education Group, University of Cambridge, developed the remote consultation pilot during lockdown in the UK, at a time when all medical student contact with patients had abruptly ceased. Students had been sent home and given remote teaching based on written or pre-recorded patient case studies.
The remote consultations were organised in June 2020 for 35 students spread across 9 primary care organisations in East Anglia: the full second year cohort of students undertaking the Cambridge Graduate Medical Course. These students had completed much of their basic clinical communication and examination skills and they all agreed to arrange internet access and a device with a camera.
Each student took part in three remote clinics. The format was: students were consulting from their own homes, the supervising doctor was based in a primary care centre or their own home and the patient was based in their own home. Microsoft Teams, AccuRx (a clinical video-consultation tool) or, if necessary, telephone were used. Detailed guidance for doctors, students and patients was provided covering the intervention, the informed consent of the patients, the study and handling the technical side.
The researchers interviewed 13 out of the 35 students on the placement and 10 out of the 14 supervising doctors, finding that, overall, the remote consultations were perceived as educationally valuable by interviewees.
“I think it was good experience to do video consultations, especially as it might be going towards that in the future.” Student in the study
All the doctors interviewed said that they selected patients for the remote consultations themselves and arranged for those patients to consent to undertaking consultation with medical students. A clear view emerged from the supervising doctors that finding ‘the right patients’, although time consuming, was key to the educational value of the experience.
AccuRx was simple to set up but often unreliable (particularly with 4 in a virtual room). Microsoft Teams had better reliability but was more complicated to use for clinical purposes. Telephone was trouble free but did not enable direct real-time supervision. The researchers point out that a remote consulting application with a virtual waiting room, approved by the NHS, would aid the efficiency of patient flow and the debriefing of students between consultations by supervisors.
All the supervisors interviewed appeared comfortable in retrospect with the idea of students consulting from home. They appeared to be very satisfied with how the students had set up and maintained an appropriate environment and appearance for home consulting. Consulting from home was acceptable to all the students interviewed.
Locations used by students included bedroom, dining room, home office and bookable rooms in university accommodation. Students described in detail the lengths to which they went to prepare their situation, including practical arrangements, for example, relocating that week to a different family house where they could have a more private room or better wifi.
The worry of potential or actual technology failure emerged as by far the most stressful and challenging aspect of the experience for the supervisors and the students. Comments by the supervising doctors suggested they took this in their stride and the students appeared to observe that this was the case.
Doctors and students identified that supervising students remotely resulted in a lack of informal contact between student and supervisor. Despite this, students generally felt that they still had good levels of rapport with their supervising doctors.
Some students expressed the view that remote consulting made their relationships with patients more difficult. One reason given was a view that it was more difficult to develop rapport. Examples quoted were reduced non-verbal communication and (when using video) the inability to interject with encouraging noises.
However, students also perceived positive effects of remote consulting on their relationship with patients. Some reported that patients often seemed more relaxed and open when at home, that housebound patients appeared incredibly pleased to have someone to talk to or that jokes concerning technical issues had the effect of building a more relaxed atmosphere.
Our study suggests that, although remote consultation does present some new practical and educational challenges for students and supervisors, these challenges can be overcome if educators take careful steps to address them.
Some experienced clinicians may feel nervous about letting medical students enter ‘remote consultation territory’ for the first time. To these clinicians, the results of our study should provide some reassurance. For example, none of the doctors interviewed expressed any concerns in retrospect about having given students supervised access to their patients in this manner.
Our study also shows how seriously the medical students treated the professional responsibilities associated with consulting from home.”
– Dr Richard Darnton, lead researcher and Director, General Practice Education Group at the University of Cambridge
Learn more about this research
Read the study
R Darnton, J Ferdinand, M Jenkins, Medical Students Consulting From Home: a qualitative evaluation of a tool for maintaining student exposure to patients during lockdown. Medical Teacher, 12 October 2020.
Lucy Lloyd, Communications, Primary Care Unit