Dataset Information

Insomnia Telemedicine OSCE (TeleOSCE): A Simulated Standardized Patient Video-Visit Case for Clerkship Students.

ABSTRACT: Introduction:Telemedicine is a growing practice with minimal training in US medical schools. Telemedicine OSCE (TeleOSCE) simulations allow students to practice this type of patient interaction in a standardized way. Methods:The Insomnia-Rural TeleOSCE was implemented as part of a required clinical clerkship for students in their second, third, or fourth year of medical school. This case addressed a patient with depression in a medically underserved area. Students performed it as a formative experience and received immediate feedback. They then completed a survey to evaluate the experience. Results:Students (n = 287) rated the quality of the experience 7.59 out of 10. Comments showed that 61 learners thought the TeleOSCE was a positive experience, 35 wanted more teaching about telemedicine, 28 improved their understanding of barriers to care, 25 expressed concern over minimal other training, 23 found the TeleOSCE important and challenging, 16 appreciated the differences between in-person and remote visits, and 15 wanted fewer distractions. Eight students worried about how they would be judged, five learned from the technical limitations, five requested more time, five were skeptical of the utility, and five saw telemedicine as triage. Discussion:The TeleOSCE allows learners to gain exposure to telemedicine in a safe simulated teaching environment and assesses learner competencies. The TeleOSCE also improves students' understanding of barriers to care and the utility of telemedicine. It logistically allows faculty to directly assess distance students on their clinical reasoning and patient communication skills.

SUBMITTER: Cantone RE

PROVIDER: S-EPMC7012306 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Insomnia Telemedicine OSCE (TeleOSCE): A Simulated Standardized Patient Video-Visit Case for Clerkship Students.

Cantone Rebecca E RE Palmer Ryan R Dodson Lisa Grill LG Biagioli Frances E FE

MedEdPORTAL : the journal of teaching and learning resources 20191227

<h4>Introduction</h4>Telemedicine is a growing practice with minimal training in US medical schools. Telemedicine OSCE (TeleOSCE) simulations allow students to practice this type of patient interaction in a standardized way.<h4>Methods</h4>The Insomnia-Rural TeleOSCE was implemented as part of a required clinical clerkship for students in their second, third, or fourth year of medical school. This case addressed a patient with depression in a medically underserved area. Students performed it as ...[more]

PMID: 32051850

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Project description:IntroductionA disconnect appears to exist for medical students between learning drug facts in a basic science context and applying those facts in a clinical context when they begin working with authentic patients. In patients with kidney dysfunction, dosages of medications that are renally eliminated often need to be adjusted, due to potentially toxic accumulation in the body. To gain insight into the thought processes and gaps underlying student thinking, we developed this standardized patient (SP) case featuring a patient with drug-related renal dysfunction.MethodsThis activity was conducted in a simulation center, in a setting reminiscent of an emergency department. It took place over 2 days, with all 23 third-year medical students at our regional campus. After reporting to the simulation center at their assigned time, students completed four different medication scenarios. This specific case involved two parts. The first part, an SP-student encounter, was allotted 15 minutes, followed by 1 minute to walk to a computer station. For the second part, writing a SOAP (subjective, objective, assessment, and plan) note, 15 minutes were allotted. This was followed by 3 minutes for the SP to provide student feedback and 1 minute to rotate to the next station. In total, 35 minutes were allotted for each student to complete the case.ResultsAll third-year medical students at our regional campus completed this activity at the midpoint of their academic year. Students were well prepared to gather necessary background information from the standardized patient. However, few made the connection between the patient's symptoms and the way in which her medications were contributing. Nor did they recommend an appropriate course of action for medications that required adjustment.DiscussionFrom this activity, we gained insight into the student thought process with regard to medication management and have been able to develop new ways of revisiting basic science concepts in clinically relevant contexts to help bridge the gap between the basic and clinical components of pharmacology education.

Project description:IntroductionTelemedicine is increasingly relied upon for care delivery in primary care, but the impact of visit type on clinical ordering behavior is uncertain.MethodsWithin Kaiser Permanente Northern California, we identified patients who self-scheduled and completed telemedicine encounters with their personal primary care provider or another available primary care provider in the same medical group, between April 1st, 2020, and October 31st, 2020, while physical distancing restrictions for COVID-19 were in place. We collected patient sociodemographic and clinical characteristics, measures of technology access, and categorized the most common primary encounter diagnoses. We measured proportions of patient-scheduled video versus telephone visits for each of eight diagnosis groups (Skin & Soft Tissue, Musculoskeletal Pain, Back Pain, General Gastrointestinal, Hypertension & Diabetes, Mental Health, Upper Respiratory, and Abdominal Pain), and compared physician orders for medications, antibiotics, lab and imaging studies by visit type within each diagnosis group.ResultsThere were 273,301 included encounters, with 86,676 (41.5%) video visits and 122,051 (58.5%) telephone visits. Of the diagnosis groups, Skin & Soft Tissue conditions had the highest proportion of video visits (59.7%), while Mental Health conditions had the highest proportion of telephone visits (71.1%). After adjusting for covariates, the overall rates of medication orders (46.6% vs. 44.5%), imaging orders (17.3% vs. 14.9%), lab orders (19.5% vs. 17.2%), and antibiotic orders (7.5% vs. 5.2%) were higher during video visits as compared to telephone visits (p < 0.05). The largest difference within diagnosis groups was for Skin & Soft Tissue conditions, where the rate of medication orders was 9.1% higher than during video visits than telephone visits (45.5% vs. 36.5%, p < 0.05).ConclusionsWe observed statistically significant differences in clinician orders by visit type during telemedicine encounters for common primary care conditions. Our findings suggest that, for certain conditions, visual information conveyed during video visits may promote clinical work-up and treatment.

Dataset Information

Insomnia Telemedicine OSCE (TeleOSCE): A Simulated Standardized Patient Video-Visit Case for Clerkship Students.

Publications

Insomnia Telemedicine OSCE (TeleOSCE): A Simulated Standardized Patient Video-Visit Case for Clerkship Students.

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