Medical students remote consulting from home and from the health centre: A survey of prevalence and supervisor perspectives

A shift to remote consulting characterised the early stages of the COVID-19 pandemic in general practice which resulted in significant changes in the delivery of medical education. It is unclear whether these changes have been sustained and how they are perceived by faculty. We surveyed a defined population of GP practices during April 2022 with questions to elicit estimates of medical student involvement in different types of remote consultation and supervisor ratings of their confidence in supervising different modalities of remote consultation. We performed thematic analysis on free text responses from a 'resistance to change’ perspective. A response rate of 96% (n = 115) was achieved. Analysis of quantitative data identified that a significant proportion of student consultations were remote, however there was a large variation between practices. Supervisor confidence was lowest for students consulting from home. Thematic analysis identified ways in which clinical supervisors may perceive the innovation to be at odds with their overriding commitments to safety, simplicity and quality. Remote consultations form a significant proportion of medical student activity in many practices. Some supervisors are reluctant to supervise medical students consulting from home and our findings suggest ways of addressing this so that the benefits of the innovation can be harnessed.

新冠疫情早期，全科医疗领域普遍转向远程问诊，这一转变极大改变了医学教育的实施模式。目前尚不明确这些变革是否得以持续，以及教职人员对此的看法如何。2022年4月，我们针对已明确划定的全科医生（General Practitioner, GP）诊疗机构群体开展了问卷调查，旨在获取医学生参与不同类型远程问诊的相关数据，以及督导教师对不同远程问诊模式开展督导工作的自信心评分。我们从“变革抵触心理”视角出发，对开放式问答的回复内容开展了主题分析。本次调查最终获得96%的有效回收率（n=115）。定量数据分析结果显示，医学生开展的问诊中有相当比例为远程问诊，但不同诊疗机构之间的差异十分显著。督导教师对学生居家开展问诊的督导自信心最低。主题分析结果揭示了临床督导教师可能认为该远程问诊创新模式与其首要秉持的安全、简洁与质量承诺相悖的具体情形。在诸多诊疗机构中，远程问诊已占据医学生临床活动的相当比重。部分督导教师不愿对居家问诊的医学生开展督导，本研究结果为解决这一问题提供了可行路径，以便充分利用该创新模式的优势。