Livestreaming GP consultations for medical education – developing a safe and sustainable approach working with patients, GPs and medical students

Problem

We need to increase primary care exposure for medical students. Current guidance suggests that 25% of the undergraduate medical curriculum should be covered in primary care, yet a survey of medical schools in 2020 demonstrated an average of 9%. Finding sufficient primary care placements is increasingly challenging and innovative and sustainable solutions to increase placement capacity are needed.

Livestreamed clinical experiences (LCE) offer potential to expand traditional in-person placements, livestreaming authentic clinical experiences to remotely located medical students. We reviewed evidence for previous LCE (using existing videoconferencing platforms) and identified limitations including patient safety concerns, technological problems, low levels of learner interactivity, and absence of underpinning educational theory. These limit the potential of LCE to address placement capacity problems.

We set out to develop a bespoke LCE platform that addresses limitations of existing LCE solutions, is acceptable to stakeholders and feasible for use in primary care, bringing more primary care consultations to more students without geographical boundaries.

Aims:

1. To develop VCE (Virtual Clinical Experiences), a bespoke, pedagogically-driven LCE platform with patient safety at its core.

2. To test the feasibility and acceptability of VCE in primary care settings for all stakeholders (patients having consultations streamed, GP Educators using VCE, students attending remote consultations).

3. To develop patient information and consent materials in conjunction with patients.

Approach

The approach followed three phases to map onto the aims:

1. We used an iterative Design-Based Research approach, informed by educational theory and stakeholders, to develop VCE.

2. We tested the feasibility and acceptability of VCE to stakeholders through pilot phases. We conducted semi-structured interviews, focus groups and questionnaires and used thematic analysis and Epistemic Network Analysis to explore stakeholders’ acceptance of VCE.

3. We worked with a Patient Participation Involvement and Engagement group using User-Centred Design Principles to develop information and consent materials. We conducted semi-structured interviews with patients to determine whether the materials were sufficient to provide informed consent.

Findings

1. We developed the VCE platform. Important features included first-person view from the clinician using smartglasses, built-in session structure including debrief, three-way communication enabling triadic consultations, chat function enabling peer collaboration and patient safety features.

2. We found high levels of acceptance for VCE among medical students. Clinical educators indicated VCE had high utility for clinical teaching, including potential to supplement placement capacity.

3. We developed a patient information video with supplementary information sheet and consent form. All patients felt the information reflected their VCE experience and facilitated informed consent.

Consequences

We have shown that a bespoke LCE platform such as VCE is feasible for use in primary care, acceptable to stakeholders, and delivers an authentic clinical experience. Such solutions have potential to expand placement capacity and offer innovative learning opportunities.