A realist evaluation of undergraduate medical teaching with remote (telephone and video) consultations in primary care

Problem

The Covid-19 pandemic has resulted in a rapid and significant increase in the number of medical consultations being conducted remotely (over telephone or video conferencing). Coupled with ongoing national restrictions and social distancing rules, this has had a profound effect on undergraduate medical education. Medical students on their general practice placements now experience consultations predominantly remotely – either observing a remote GP-patient consultation or conducting a consultation online with a patient, whilst being observed by their GP supervisor. Current evidence demonstrates effectiveness of remote consultations for clinicians and patients but highlights a paucity of guidance to facilitate this teaching modality. As we transition to remote models of care, creating optimum student learning experiences is imperative for maintaining clinical competencies. This study aims to evaluate the use of remote consultations to teach medical students in this setting.

Approach

The study uses a realist evaluation, an approach used to evaluate real-world interventions which are not yet well understood. It is used to explore features of this new teaching intervention, in order to consider what elements lead to success or failure. Participants will include medical students and GP tutors who have experienced teaching or learning through remote consultations in primary care. Participants’ views will be gathered using a questionnaire and semi-structured interviews. The questionnaire will examine participants’ experiences, attitudes and preferences about teaching using remote consultations in primary care. This will include: the types of teaching/learning activities, the advantages and disadvantages of teaching with remote consultations, and how teaching with remote consultations affects the interaction between students, patients, and GP tutors. The data from the questionnaires will be used to identify topics to be covered in the semi-structured interviews. The interviews will explore participants’ thoughts and experiences in more depth.The study will consider features of the learning environment (‘contexts’), how the students and GP tutors responded to these (‘mechanisms’) and what the consequences were, in terms of the success of the learning activity (‘outcomes’).

Findings

Initial programme theory identified multiple contexts and mechanisms for optimum teaching and learning outcomes. These are broadly categorised into five themes; engagement, motivation, perception, preparation and experience. These theories will be explored and tested in the second phase of data collection within a realist evaluation, which is currently under way.

Consequences

With a shortfall in students choosing a career in general practice, fostering a positive learning experience is important, particularly in the current climate where learning has been significantly disrupted. It is known that medical students’ exposure to learning opportunities in general practice impacts their future career choices. It is intended that managing the identified facilitators and barriers to learning with remote consultations will help to ultimately improve learning and teaching experiences for medical students and GP tutors.