Students’ and tutors’ experiences of remote ‘student–patient’ consultations

Background:Remote consulting has become part of the medical student clinical experience in pri-mary care, but little research exists regarding the impact on learning.Aim:To describe the experiences of General Practitioner (GP) educators and medical students inusing student-led remote consultations as an educational tool.Method:A qualitative, explorative study conducted at four UK medical schools. GP educators andmedical students were purposively sampled and interviewed.Results:Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferen-tiated patients, clinical reasoning, patient inclusion in student education, student–patient inter-action, and student–doctor interaction.Discussion:Remote consulting has become part of the clinical placement experience. This hasbeen found to expose students to a wider variety of clinical presentations. Verbal communication,history-taking, triage, and clinical reasoning skills were practised through remote consulting, butexamination skills development was lacking. Students found building rapport more challenging,although this was mitigated by having more time with patients. Greater clinical risk was perceivedin remote consulting, which had potential to negatively impact students’psychological safety.Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships.Student autonomy and independence increased due to greater participation and responsibility.Pre-selection of patients could be helpful but had potential to expose students to lowercomplexity patients

Digital undergraduate medical education and patient and carer involvement: a rapid systematic review of current practice

BACKGROUND: Involving patients and carers in medical students' learning aims to centralise the perspective of healthcare users and supports our future medical workforce in the development of key skills. Medical schools are increasingly using digital technology for teaching and it is timely to understand how to maintain patient and carer involvement in this context. METHODS: Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported authentic patient or carer involvement in undergraduate medical education where technology was also used. Study quality was assessed by the Mixed Methods Appraisal Tool (MMAT). Levels of patient or carer involvement were assessed using Towle et al.'s (2010) taxonomy, from Level 1 (lowest level) to Level 6 (highest level). RESULTS: Twenty studies were included in this systematic review. In 70% of studies, patients and carers featured in video or web-based case scenarios with no interaction between healthcare users and students. The remaining 30% of studies reported real-time interactions between students and patients via remote clinical encounters. Digital teaching sessions involving patients or carers were perceived to be valuable by students and educators, and increased student engagement, patient-centred attitudes, clinical knowledge, and communication skills. No studies reported the perspective of patients or carers. DISCUSSION: Digital technology has not yet driven higher levels of patient and carer involvement in medical training. "Live" interactions between students and patients are becoming more common but challenges need addressing to ensure positive experiences for all involved. Future teaching should enhance the role of patients and carers in medical education and support them to overcome any potential barriers to doing so remotely

Digital undergraduate medical education and patient and carer involvement: a rapid systematic review of current practice

Background: Involving patients and carers in medical students’ learning aims to centralise the perspective of healthcare users and supports our future medical workforce in the development of key skills. Medical schools are increasingly using digital technology for teaching and it is timely to understand how to maintain patient and carer involvement in this context. Methods: Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported authentic patient or carer involvement in undergraduate medical education where technology was also used. Study quality was assessed by the Mixed Methods Appraisal Tool (MMAT). Levels of patient or carer involvement were assessed using Towle et al.’s (2010) taxonomy, from Level 1 (lowest level) to Level 6 (highest level). Results: Twenty studies were included in this systematic review. In 70% of studies, patients and carers featured in video or web-based case scenarios with no interaction between healthcare users and students. The remaining 30% of studies reported real-time interactions between students and patients via remote clinical encounters. Digital teaching sessions involving patients or carers were perceived to be valuable by students and educators, and increased student engagement, patient-centred attitudes, clinical knowledge, and communication skills. No studies reported the perspective of patients or carers. Discussion: Digital technology has not yet driven higher levels of patient and carer involvement in medical training. “Live” interactions between students and patients are becoming more common but challenges need addressing to ensure positive experiences for all involved. Future teaching should enhance the role of patients and carers in medical education and support them to overcome any potential barriers to doing so remotely

Students' and tutors' experiences of remote 'student-patient' consultations

Background: Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. Aim: To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. Method: A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. Results: Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student–patient interaction, and student–doctor interaction. Discussion: Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students’ psychological safety. Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients

Students’ and tutors’ experiences of remote ‘student–patient’ consultations

Background: Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. Aim: To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. Method: A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. Results: Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student–patient interaction, and student–doctor interaction. Discussion: Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students’ psychological safety. Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients

The effect of post-injection ¹⁸F-FDG PET scanning time on texture analysis of peripheral nerve sheath tumours in neurofibromatosis-1

Abstract Background Texture features are being increasingly evaluated in 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) as adjunctive imaging biomarkers in a number of different cancers. Whilst studies have reported repeatability between scans, there have been no studies that have specifically investigated the effect that the time of acquisition post-injection of 18F-FDG has on texture features. The aim of this study was to investigate if texture features change between scans performed at different time points post-injection. Results Fifty-four patients (30 male, 24 female, mean age 35.1 years) with neurofibromatosis-1 and suspected malignant transformation of a neurofibroma underwent 18F-FDG PET/computed tomography (CT) scans at 101.5 ± 15.0 and 251.7 ± 18.4 min post-injection of 350 MBq 18F-FDG to a standard clinical protocol. Following tumour segmentation on both early and late scans, first- (n = 37), second- (n = 25) and high-order (n = 31) statistical features, as well as fractal texture features (n = 6), were calculated and a comparison was made between the early and late scans for each feature. Of the 54 tumours, 30 were benign and 24 malignant on histological analysis or on clinical follow-up for at least 5 years. Overall, 25/37 first-order, 9/25 second-order, 13/31 high-order and 3/6 fractal features changed significantly (p < 0.05) between early and late scans. The corresponding proportions for the 30 benign tumours alone were 22/37, 7/25, 8/31 and 2/6 and for the 24 malignant tumours, 11/37, 6/25, 8/31 and 0/6, respectively. Conclusions Several texture features change with time post-injection of 18F-FDG. Thus, when comparing texture features in intra- and inter-patient studies, it is essential that scans are obtained at a consistent time post-injection of 18F-FDG