Re-entering clinical rotations amidst the COVID pandemic introduces a host of uncertainties for medical students. Chief among them, navigating the unknown frontier of telemedicine. Medical education prepares medical students extremely well for taking a history, observing the patient, and completing a physical exam when the patient is present.
However, after a COVID-related hiatus, I learned that my first rotation back would be a combination of in-person and telemedicine pediatric encounters. As a medical student, I have been taught the importance of a complete and thorough physical exam to test my diagnoses. When I thought about having to care for patients remotely, I felt handicapped knowing that one of my best tools was effectively neutralized. I was also worried that the quality of my patient interactions would be reduced. Telemedicine was a foreign concept that I had never been taught.
Although the use of telemedicine has been increasing in recent years, it remains largely unaddressed in medical school curricula. The rise of telemedicine during the pandemic has demonstrated the importance of teaching telemedicine competencies to medical students. In a recent Academic Medicine article, Hindman and colleagues demonstrated the benefits associated with a telemedicine curriculum. They found that incorporation of a telemedicine curriculum into the pediatric core clerkship improved the quality and value of care provided by students in an objective structured clinical examination (OSCE) encounter. Students who participated in the telemedicine curriculum scored higher on the OSCE and ordered fewer tests that were not indicated.
My medical school offered an abbreviated version of the curriculum described by Hindman and colleagues prior to restarting clinical rotations. Through this curriculum, I learned how to adapt my history taking and physical exam skills to a telemedicine encounter. The most beneficial portion of this curriculum was that it gave me a safe space to practice a new skill set. I felt that this practice was invaluable to my success in the telemedicine clinical space.
Despite the initial uncertainties, telemedicine was an extremely enjoyable experience for both myself and my preceptor. We were able to simulate an in-person clinical encounter in which I would log-on first, take the history, and do as much of the physical exam as possible. I would then call my preceptor and present the patient over the phone. We would log back on together to discuss the plan with the patient. Even though I lost some of the physical exam components, during these visits, I was able to observe my patients at home and gain better insight into their developmental milestones. Overall, participating in telemedicine was an important learning experience in my clinical education that will be extremely important as telemedicine becomes an even more dominant part of the health care system in the future.
The increasing participation of medical students in telemedicine stresses the importance of incorporating telehealth education into curricula. Medical students need to be taught the basics of telemedicine just as they are taught how to take a history and do a physical exam as first-year students. With the increasing prevalence of telehealth, especially during this pandemic, students should be provided with the tools they need to succeed.
By: Jill L. Sorcher
J. Sorcher is a fourth-year medical student at the Johns Hopkins University School of Medicine, Baltimore, Maryland.
Hindman DJ, Kochis SR, Apfel A, et al. Improving medical students’ OSCE performance in telehealth: The effects of a telephone medicine curriculum [published online ahead of print July 28, 2020]. Acad Med. doi: 10.1097/ACM.0000000000003622