Virtual clinical teaching can involve the preceptor and student in the same place (clinic) and the patient is in a remote location, or all three parties in separate locations, where you are using either a telephone or virtual platform to connect.
The information below is curated from discussions with virtual clinical teaching pioneers, peer-reviewed papers, and resources developed by physician and non-physician experts as Faculties of Medicine have worked to provide patient care and medical student education during the COVID-19 pandemic. As experience accumulates and we continue to learn best practices in virtual clinical teaching alongside clinical educators, we will update this website.
Tips and suggestions for optimizing Webside Manner for students
Providing students with an orientation to your clinic and virtual care practices is more important than ever in this new era of virtual care. Take some time to co-create teaching and learning goals with your student so that you have matched expectations for how you will work together in the virtual environment. Setting shared goals with your learner also makes it easier to provide feedback on the student’s performance in the form of a dialogue of what needs to be learned and accomplished. Iterative check-ins are also important to see if both the student and teacher’s goals are being accomplished and provide an opportunity to plan future ones.
Given the best practices for treatment in a telehealth visit, clinicians can consider having their learners begin by:
- Managing the patient virtual waiting room
- Engaging with the patient to go over the visit and obtain consent
- Helping the patient prepare a safe and appropriate physical space
- Ensuring that background noise is minimized and that (patient and clinician) lighting is free from obvious backlighting, deeps shadows, and distracting glare
- Checking that clothing allows for full movement and observation
Whatever technology and platforms you are already using are likely the best technology to teach with. Don’t overthink it. Students will learn from you (and alongside you) and your patients about providing virtual care regardless of what technology your clinic uses. If you have specific questions about licensing requirements, and what technology platforms are available for virtual care, please check with your professional association for specific COVID-19 support [i]
[i] Zoom licenses available free of charge for community providers. DTO, in partnership with the Provincial Health Services Authority (PHSA), is providing Zoom for Healthcare licenses to community providers (family physicians, nurse practitioners, and specialists). Please follow the above link for more information.
Observation and feedback will vary among teachers and clinical schedules but some suggestions based on others’ experiences involve:
- Morning check-ins with your students to go over the schedule, what patients you would like them to see and what their goals are for the day.
- As you provide virtual care, bring the student along with you and teach in the presence of the patient. Discuss what your role will be and what the student’s role will be. Then you can provide feedback to the student in the presence of the patient so that you can correct the student and educate your patient at the same time.
- End-of-day wrap up with your learner in your clinic or virtually, depending on your situation
- In order for your feedback to be meaningful and specific, encourage your students to take notes throughout the day as they see patients and jot down any further questions they have and preceptors are also encouraged to take notes on students’ general performance and related to their learning goals. Remember to remind the student to ensure confidentiality with any patient notes.
Telehealth for Teachers and Learners
Introduction to Telehealth platforms (Basics) and a Patient Encounter
See Dr. Arman Abdalkhani, Associate Director, UGME program presenting a 3-way medical student Telehealth teaching video, accompanied by a brief powerpoint.
Skills that you can effectively observe students do virtually include:
- Communication skills – virtual care often relies on a detailed patient history so you can observe your students listening skills and how effectively the student communicates with the patient.
- Clinical reasoning skills – since you may not have the breadth or variety of cases that you are providing care virtually for, you can spend time probing students’ depth of knowledge through exploring alternative scenarios.
- Selectivity skills – how well do students triage which patients need to come into the clinic, despite the current risks associated with in-clinic visits? Would the student’s treatment plan be different if pandemic measures were not in place within clinics? Preceptors can probe deeper thinking on patient-care decisions.
- Scholar skills – As clinic procedures and processes rapidly change, now is a great time to consider QI or practice improvement projects your student can support.
- Physical exam skills – while attempting a virtual physical exam is difficult at best and not always possible with certain types exams, some preceptors have found creative solutions to assess students’ ability to perform some physical exams. For example, the following document contains relevant information on using telehealth for musculoskeletal physiotherapy: https://doi.org/10.1016/j.msksp.2020.102193
- Patient education skills
Do you have experience teaching virtually and would like to share your experience with your peers? Write about something you have learned, a challenge you have experienced and what you did to overcome it, or a virtual clinical teaching success story, enter the details below.