Effect of a standardized patient encounter on first year medical student confidence and satisfaction with telemedicine

Methods

This study was approved by the Institutional Review Board (IRB) at Edward Via College of Osteopathic Medicine (#1687953-2). The informed consent requirement was waived by the IRB, as participation in the study presented no more than minimal risk of harm to subjects and involved no procedures for which written consent is normally required outside of the research context.

First year medical students enrolled at Edward Via College of Osteopathic Medicine-Carolinas (VCOM-Carolinas) campus were recruited by email. Participants were provided information on the study and consent was assumed by voluntary participation. A link to the survey (Supplementary Material) was sent to all 162 first year medical students immediately before participation in a standardized patient encounter that was part of the medical school curriculum; the email containing the survey link was sent on August 16, 2020 and the standardized patient encounter occurred on August 17, 2020. The same survey (Supplementary Material) was distributed immediately following the encounter on August 17, 2020 and remained open until September 4, 2020. The 12 item survey (Supplementary Material) was developed by three of the authors (E.U., G.W., T.L). and assessed, on a five point Likert scale, students’ confidence with using telemedicine and their anticipated level of satisfaction with telemedicine. The survey response scale included the following options: “not confident,” “a little confident,” “somewhat confident,” “confident,” and “extremely confident.” Demographic information, including participant age and highest completed level of education, were also collected. All survey responses were collected anonymously.

Results

Of the 162 first year medical students enrolled at VCOM-Carolinas, 103 (63.6%) completed the preencounter survey and 74 (45.7%) completed the postencounter survey after the encounter; 29 (28.2%) were lost between the two survey administrations. There was no statistically significant differences in age or level of education between those who completed the survey before and after the encounter (p=0.995; Table 1).

Before the patient encounter, 20 participants (19.4%) reported being “not confident,” 37 (35.9%) reported being “a little confident,” 35 (34.0%) reported being “somewhat confident,” 10 (9.7%) reported being “confident,” and one (1.0%) reported being “extremely confident” in their ability to conduct a patient interview over a telemedicine platform. After completing the encounter, participant confidence increased, with the following response rates: one (1.4%) “not confident,” 15 (20.3%) “a little confident,” 24 (32.4%) “somewhat confident,” 32 (43.2%) “confident,” and two (2.7%) “extremely confident” (p<0.001; Figure 1).

Figure 1:

First year medical students’ self-reported confidence in their ability to conduct patient encounters over a telemedicine platform.

For questions regarding participants’ confidence establishing a doctor-patient relationship using telemedicine, the following responses were entered to the preencounter survey: 18 participants (17.5%) reported being “not confident,” 32 (31.1%) reported being “a little confident,” 35 (34.0%) reported being “somewhat confident,” 15 (14.6%) reported being “confident,” and three (2.9%) reported being “extremely confident” in their ability. After completing the simulated patient encounter, participant confidence increased, with four (5.4%) reporting that they were “not confident,” 12 (16.2%) reporting “a little confident,” 17 (23.0%) reporting “somewhat confident,” 28 (37.8%) reporting “confident,” and 13 (17.6%) reporting they felt “extremely confident” (p<0.001; Figure 2).

Figure 2:

First year medical students’ self-reported confidence in their ability to establish a doctor-patient relationship using telemedicine.

Prior to the encounter, six participants (5.9%) reported feeling “not satisfied” that telemedicine experiences helped them to prepare for clinical practice; 26 (25.5%) felt “a little satisfied,” 43 (42.2%) felt “somewhat satisfied,” 24 (23.5%) felt “satisfied,” and three (2.9%) felt “very satisfied.” Postencounter, five participants (6.8%) were “not satisfied,” nine (12.2%) were “a little satisfied,” 21 (28.4%) were “somewhat satisfied,” 28 (37.8%) were “satisfied,” and 11 (4.9%) were “very satisfied” that the telemedicine experience helped to prepared for them for clinical practice (p<0.001; Figure 3).

Figure 3:

First year medical students’ satisfaction with how a telemedicine standardized patient experience has prepared them for clinical experience.

As a group, participants reported greater confidence in their ability to perform telemedicine consultation (p<0.001), conduct a patient interview (p<0.001), conduct a patient interview over telemedicine (p<0.001), conduct an augmented reality physical examination over telemedicine (p<0.001), diagnose a patient’s condition over telemedicine (p<0.001), recommend a treatment plan via telemedicine (p<0.001), establish a doctor-patient relationship over telemedicine (p<0.001) after the telemedicine standardized patient encounter. Participants reported increased satisfaction with telemedicine (p<0.001) and increased agreement that the telemedicine standardized patient experience helped their preparation for clinical practice (p=0.02) (Table 2).

Discussion

As the COVID-19 pandemic rapidly changes the landscape of clinical medicine, it is pertinent for medical students to practice interacting with patients over telemedicine platforms. While it is difficult to quantify the number of medical schools presently using telemedicine in their curricula due to the lack of contemporary data in the literature, the American Medical Association previously articulated a need for more telemedicine-specific education for medical students and residents alike [7]. A mixed-methods review [8] of 17 medical schools found that the clerkship phase of medical education is where the majority focused most of their telemedicine learning, as interacting with patients online has become a large part of clinical practice. Only 10 of the 17 medical schools (59%) in that study [8] included telemedicine experiences for patient encounters or standardized patients in the preclinical years. A relative lack of exposure to telemedicine may leave medical students and new residents unprepared in a clinical environment. Students in a previous study [5] recognized the benefit and relevance of additional telemedicine training to their future practice.

In our study, the addition of a standardized telemedicine encounter to the undergraduate medical education curriculum afforded first year medical students the opportunity to evaluate their own confidence and satisfaction with telemedicine. A higher number of participants reported confidence and satisfaction with a telemedicine encounter as well as confidence and satisfaction in their ability to conduct encounters, connect with patients, and preparedness to use these skills into their future practice.

Osteopathic physicians should be aware of these findings because providing excellent care despite current limitations and social distancing guidelines is paramount for our patients. Telemedicine is a solution that keep patients, providers, and learners safe from unnecessary harm; as such, it is an invaluable resource that will remain part of the clinical care landscape even after the COVID-10 pandemic. As osteopathic physicians, we understand the impact this may have on a person’s overall well being [9]. Using telemedicine in a way that is effective for medical care and maintains the doctor-patient relationship depends on developing unique skills [6]. Medical schools may therefore consider adding telemedicine training into undergraduate medical curricula.

Conclusions

Our study revealed a self-reported lack of confidence and satisfaction in telemedicine among first year medical students at Edward Via College of Osteopathic Medicine-Carolinas that was improved after a standardized patient experience over a telemedicine platform. Future studies should investigate similar changes among third and fourth year medical students because students later in their training, who are encountering numerous patients per day either in person or via telemedicine, may provide deeper insight into the utility of telemedicine education during medical school.