Going Virtual, Both in Class and the Clinic

Yash B. Shah


March 25, 2022

The COVID-19 pandemic has yielded profound advances in our ability to use telemedicine services for patients in the form of routine patient visits, consults, and even physical exams. With social distancing guidelines and closures of medical facilities to prevent disease transmission, countless patients saw nonurgent appointments and screenings canceled.

Over time, telemedicine was promoted as a stopgap solution to prevent patients from losing not only physician services but also communicative opportunities with their medical providers.

Although it was greatly propelled by the COVID-19 pandemic, telemedicine has been a slowly growing industry throughout the last decade. During the pandemic, telehealth visits increased by 154%. In the early and deadly months of the pandemic, nearly one third of doctor's visits occurred over teleplatforms, and 95% of health centers now report telehealth capabilities.

The use of telehealth for regular office visits offers many perks to patients and doctors alike. Namely, telehealth — and the sophisticated platforms that accompany this technology — offers convenience, allowing patients to check in with their providers more frequently over video call or text without having to travel to the office.

Many such platforms, integrated with the accompanying electronic medical records, are currently used by larger healthcare systems and are shared among satellite facilities, providing patients the ability to view laboratory results and imaging reports as well as communicate with their providers, enhancing engagement and boosting the patient experience.

In addition, telehealth helps patients with more complex, rarer conditions attain high-quality care from tertiary medical centers, which may be located further from home in major cities.

Telehealth visits may also reduce costs over the long run. Overall, the reduction in cost and lack of need to travel will boost access, especially for our most marginalized communities.

According to Robert Glatter, assistant professor of emergency medicine at Lenox Hill Hospital and editor-at-large for Medscape Emergency Medicine, other methods of incorporation of telemedicine include forward-triage and remote consults.

The emergency department (ED) can greatly benefit from initial online visits before patients are transferred to the department for further care, and this model has been growing in popularity. The ability to sort and categorize patients prior to a visit to the ED can reduce crowding and streamline care by improving health outcomes while enhancing patient experience.

This direct-to-consumer approach further reduces the chances of infectious exposures to healthcare workers, hospital staff, and low-risk patients who would have made an ED visit if not for the advent of telemedicine services.

Due to the lasting nature of this change, it is important that we prepare the future generation of physicians to provide optimal care via this new platform. Obviously, the methods of conducting physical exams, taking patient interviews, or even offering empathetic communication are profoundly different when done over a video call.

Although a large portion of medical services will return to in-person visits after the pandemic, and some services inherently cannot be done remotely, telemedicine is definitely here to stay. As a result, doctors will need to develop the skills to provide high-quality care in this setting. In the unfortunate case of another future pandemic, our doctors will be better equipped to seamlessly transition to remote care.

Decades ago, medical schools solely provided science-based didactic education in large lecture halls, aiming to provide students with a strong science foundation before they transitioned to the hospital floors for their rotations and clerkships. Over time, medical education incorporated an increasingly patient-focused curriculum, introducing small group sessions and case-based learning to improve future physicians' soft skills and critical thinking abilities.

The next era of medical education should continue to build upon this trend.

Of course, a strong foundation of science is important. However, this indicates not only that it is inefficient to focus on medical students' exclusively learning basic science, but also that our future physicians must prioritize humanistic skills and emotional intelligence over simply knowledge. Moreover, with the arrival of artificial intelligence and robotics, soft skills and humanism will only grow in importance. Therefore, it only makes sense to harness and embrace such priorities going forward.

With the emergence of telemedicine, clinical skills sessions should incorporate these additional skills. Adding patient case simulations where students learn how to perform physical exam techniques remotely can help.

Similarly, teaching students how to communicate effectively over a video call platform can be important to increase patient comfort while reducing awkwardness or miscommunication. That said, subtle nonverbal clues from facial expressions and eye movements become more important in the realm of telemedicine. Such nuanced skills are honed from practice alongside mentors and peers.

With large numbers of Americans living with chronic conditions, we will see more health devices and monitoring tools generating data for physicians on a routine basis. This has already started with the Apple Watch and other similar devices but will expand to include nascent technologies that allow seamless integration with electronic medical records and communication with large silos of data repositories.

Many experts foresee daily monitoring of key biological variables for patients, with emerging data silos being engineered to monitor such variables while being staffed by "patient care monitoring centers of excellence" to integrate, analyze, and interpret changes in patients' biological state of health. Doctors would then be alerted when abnormal patterns in functioning emerge that require evaluation and management.

Under development are new artificial intelligence avatars that are being used to triage ED patients, perform initial history-taking or consults, or check in with patients with chronic disease on a daily basis to alert live physicians when issues arise. These technologies offer great promise for patient outcomes, efficiency, cost reduction, and disease prevention, but they are also concerning, as they create the potential for a dehumanized form of medical care.

Clinical skills classes discussing the incorporation of these technologies with best clinical practice will be helpful in preparing our future healthcare providers.

Discussing considerations such as telehealth etiquette, security, and privacy when reviewing health information online; how to improve the personal connection and patient experience when meeting remotely; and the conduct of procedures or diagnostics in a remote setting will better equip medical students for the future of medicine.

There is a high degree of probability that the number of patient encounters conducted remotely will only continue to grow. Today's medical schools should get ahead of this trend to prepare our future doctors for a smooth transition, and so that they can contribute to optimizing the incorporation of these new technologies for our patients' benefit.

Robert Glatter, assistant professor of emergency medicine at Lenox Hill Hospital and editor-at-large for Medscape Emergency Medicine, was an expert contributor to this piece.

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About Yash B. Shah
Yash Shah is a first-year medical student at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. He earned a bachelor of science in premedicine from Penn State University. Prior to attending medical school, Yash worked on clinical and translational research in hematology/oncology at the Children's Hospital of Philadelphia. Yash has long-standing interests in advancing medical education, improving healthcare policy and economics, and working with cancer patients. In his free time, he enjoys playing tennis, rooting for the Eagles, reading, and traveling.


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