The COVID-19 pandemic has changed the way medical education has been delivered. For those in the clinical phase of their training, restrictions on social distancing and the unpredictability surrounding enforced lockdowns have meant face-to-face clinical time is not guaranteed. Virtual clinics can allow the delivery of an educational experience with several benefits.
Virtual clinics can be used exclusively for education. Setting a template allowing for four to six new patients over three hours allows both the trainee (or student) to observe a variety of expert patients and for senior clinicians to provide effective education.
Parents should be informed that their clinic will be a teaching clinic and may operate slightly differently than usual but with no change to the quality of care. Clinicians may also consider certain patients as future expert patients in the same way they are kept in mind for clinical exams.
Here are some top tips based on our experiences that should ease your foray into using virtual clinics as an educational tool. We’ll lay them out in three stages..
1. The Groundwork (Preparation)
2. Delivery (Of Content)
3. Scaffolding
Doing the groundwork
Preparation is crucial to ensure a smooth, efficacious learning opportunity. This is true whether it is delivered physically or virtually. Setting the aims and objectives of the sessions ensures educators and students (undergraduate, postgraduate and trainee clinicians, but we’ll call them students from now on) are clear on what skills or lessons will be elicited from the session. Here are some things to consider whilst setting up the clinic:-
1. Set the agenda
Inform and consent patients and parents in advance. Let them know that the student will initially lead the consultation (via video or telephone) and that you will be in the same virtual room to observe. The student will then lead the consultation.
After the initial consultation, the call will be paused (or the patient will be placed in the virtual waiting room) to allow the student to discuss their findings and develop differential diagnoses with the senior doctor. Then, let the family know you will call them back after five or ten minutes to continue the consultation.
Studies have shown that patients and consultants are fully receptive to student-led consultations. There is no drop in quality for students seeking to explore the lived experiences of their patients, and patients themselves can provide a wealth of education far beyond any textbook.
2. Decide on the nature of the clinic – first presentation or follow-up?
New patient clinics are wonderful for obtaining structured histories and helping students develop differential diagnoses and management plans. Plenty of time should be allowed for the students to achieve this.
From personal experience, I would allocate at least 40-60 minutes for a new patient. The first half of the consultation should be given to the student to take a robust history. The next ten to fifteen minutes should then be spent discussing the differential diagnosis and plan with appropriate reasoning. Doing this, when the dialogue is only between the clinician and student, can help the formative element of these clinics. Then, the clinician can bring the patient back to the virtual room to discuss the management plan.
Follow-up clinics allow students to learn from the clinician’s initial letters. You can allocate time for students to review them to consolidate their learning.
During these sessions, you can also observe communication skills and provide feedback. Student-run clinics may improve the quality of care and education itself. Having real-time patient interaction via virtual clinics provides the ability to gather confidence in taking detailed histories, develop effective communication skills and develop overall professionalism.
3. Focus on developing clinical skills
While there is no alternative to the physical exam, virtual consultations provide excellent opportunities to develop clinical reasoning skills and understand the importance of a focused history. Clinicians can help develop clinical reasoning as they sift through the information. This allows the student to gain a more holistic learning experience as they follow the patient’s journey from the start to the end.
The Delivery
Here are some ways to maximise the delivery of educational content.
4. Encourage participation in clinic through supervised learning events (SLEs)
Virtual clinics can be a tool to help trainees and students complete supervised learning events (SLEs). These clinics can be ideal for assessments through observed interaction (like the mini-CEX) or case-based discussion. Running SLEs through virtual clinics provides scope to strengthen the event’s aims with a summative focus by having regular virtual clinics over a rotation. This may decrease the burden on trainees during the pandemic or times of high patient load.
5. Provide formative feedback
Evidence suggests that formative assessment and feedback are the most significant development tools for shaping future clinicians. This will narrow the gap between the set standard and the observed performance, aiming to develop skills that improve confidence and provide support when necessary. Doing so via a virtual setting allows for constructive dialogue to take place.
Focused feedback around professionalism, communication skills, and knowledge can be provided, reinforcing a positive learning environment.
6. Solicit patient feedback
Students benefit hugely from receiving feedback from the patient and their carers.
The student must provide consent as well as family.
A recent study in 2019 by Rubliauskas et al. found that most patients thought involving students in their consultations would not influence care outcomes. Baines et al. (2018) observed that patient feedback was more influential in changing practice and habits when it was specific. Incorporating this into the structured breakdown of a virtual clinic can assist in reflection and development.
Scaffold Learning
7. Encourage retrieval practice with the patient
The student can follow the journey of the patient. You can plan for a quick catch-up with the student within the fortnight to review any investigations and discuss what they mean. Retrieval practice has been shown to enhance learning from clinical encounters and lead to superior examination performance, embedding long-term learning.
8. Get students to reflect and action a plan
Students should be encouraged to reflect on what they have seen and experienced. Effective reflection strengthens critical thinking and communication skills and is the basis for formulating an educational plan. This allows the teacher to tailor learning opportunities and collaborate with the students to create the most effective virtual learning environment.
9. Encourage attendance at multi-disciplinary team (MDT) meetings
Students joining MDT clinics gain exposure to the varied aspects of the team. A recent pilot survey undertaken by Trivedi (2019) showed that inclusion at these meetings has overwhelmingly positive educational value.
Beyond all this, the best ideas often come from feedback from students. Understanding the flaws and strengths of virtual learning environments provides sources for improvement. Feedback from the patient and family can also provide novel ideas on how to improve patient-professional interactions best. The clinicians also get ongoing education on how best to talk with patients.
Virtual clinics foster good learning opportunities. While it might seem arduous to set up and occasionally technology might fail, educators need to reinvent the way we teach and train the doctors of the future. Technology-enhanced learning is here to stay and is expected to advance rapidly. It’s time to become an early adopter.
References
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