Introduction
Methods
Study inclusion criteria
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Participants: This review included medical students in any year and stage of training.
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Interventions: Articles discussing the delivery of healthcare through telemedicine in any setting and the incorporation of telemedicine teaching and learning in medical school curricula were included. Telephone consultations were also included.
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Publication date: No time or date restrictions were applied
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Language: Studies in any language were included.
Study exclusion criteria
Literature search strategy
Results and discussion
Article | Objectives | Method | Population | Major Findings | Limitations |
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Abraham, HN et al [1] | – a clerkship for students during COVID-19 | Cross-sectional qualitative study | 20 third-year medical students at Medical Centre, USA | – Provided diverse clinical experiences | No data on patient satisfaction with model |
– increase student skill & confidence in telehealth with online modules | – Improved student confidence & appreciation of telehealth | ||||
– participate in weekly telehealth clinic | – High student satisfaction | ||||
– Learned to adapt to overcome challenges | |||||
Bulik, RJ & GS Shokar [7] | To implement & evaluate a primary care telemedicine elective for fourth-year medical students | Qualitative study | 7 fourth-year medical students at US University | – Telemedicine elective a valuable experience | Participation in the elective was self-determined |
– “Very educational & inspiring” | |||||
– “Look forward to incorporating electronic health into my medical practice” | |||||
– “The advantages of telemedicine to the field of pathology in particular far outweigh any disadvantages” | |||||
Holubová, A et al [15] | To give medical students insight into current diabetes care technologies | Cross-sectional study | 28 medical students at University, Czech Republic | 77% evaluated the practical part as very suitable to be included in lectures | Limited results available |
Iancu, AM et al [16] | To discuss telehealth opportunities for medical students during & beyond COVID-19 | Viewpoint | Medical Students | – Telemedicine skills eg communication, physical exam, professionalism, technological literacy, should be incorporated into medical school curricula | |
– Education through clinical e-visits & virtual consults | |||||
– Difficulties: Technical challenges, patient discomfort, impaired provider-patient relationships | |||||
Knight, P et al [18] | To support the use of telehealth consultations for medical education | Mixed methods prospective cohort study | 2 medical student cohorts (n = 74, n = 76) at Australian University | - Respondents agreed/strongly agreed that the interpersonal aspects were satisfactory | – Short study timeframe |
– Educational opportunities specific to mental health consulting | – Financial incentive payments through Medicare | ||||
– Improved job readiness | |||||
– Clinical benefits: Continuity of care, timely access to specialists, quicker referrals & follow-ups | |||||
– Poor picture & sound quality |
Article | Objectives | Method | Population | Major Findings | Limitations |
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Pathipati, AS et al [22] | To propose a model for incorporation of telemedicine training into medical school curricula | Viewpoint | Medical Students in all years | – Formal telemedicine training should be incorporated into medical schools | |
– Consider “digital call” & “digital health rotations” | |||||
– Challenges include carrying out physical exams, technology (blood pressure), pain management | |||||
Rolak, S. et al. [25] | To discuss current challenges in medical student education due to COVID-19, responses that have been adopted, and future directions | Opinion review | Medical students in all years | – Benefits: reduces face-to-face contact, reduce risk for viral transmission & need for travel | – Small sample size |
– Can help with routine outpatient telemedicine visits & patient education | Not blinded | ||||
– Challenges include administrative barriers, payment discrepancies | |||||
– Future suggestions include supervised telemedicine visits, curriculum on virtual etiquette & remote physical exam skills | |||||
Shawagfeh, A. & E. Shanina [27] | To develop a formal Tele-Neurology training program for medical students during their neurology Clerkship | Pilot study | 97 medical students (41 fourth year, 56 third year) at US University | – Gained knowledge on telemedicine basics & principles | |
– Improved interprofessional communication, ability to interpret common tests & explain them to the patient | |||||
– Biggest challenge is taking initiative & providing orientation | |||||
Waseh, S. & A. P. Dicker [30] | To discuss current experiences & learnings from medical schools implementing telemedicine into medical education | Mixed methods review | 9 texts meeting inclusion criteria; 70 institutions | – > 60 allopathic medical schools in the USA provide some form of telemedicine experience in their clerkship offerings | - Small sample size |
– 53% (9/17) medical schools utilize patient encounters to develop telemedicine competencies in medical students | – Need further studies on efficacy of telemedicine implementation | ||||
Yaghobian, S., et al. [34] | To examine the knowledge, attitudes, and practices of telemedicine education and training | Cross-sectional study | 3312 medical students (69.8%) and residents in France | – > 50% felt telemedicine could improve medical practice | - Low participation rates |
– 82.8% believed telemedicine improved access to care | – Overrepresentation of informed students (participation bias) | ||||
– 84.7% who had not practised telemedicine wanted to before the end of their studies |
Article | Objectives | Method | Population | Major Findings | Limitations |
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Annis, T et al. [2] | To evaluate a remote patient monitoring system for patients with COVID-19 symptoms | Mixed methods cross-sectional study | 300 patients with COVID-19 symptoms in the USA | – Developed an effective COVID-19 remote monitoring pathway staffed by medical students, residents, & supervising physicians | Requires stronger analysis of patient experience & factors influencing patient participation in pathway |
– High patient satisfaction | |||||
Berwick, KL & L Applebee [5] | To discuss concerns relating to telephone consultations and how these may lessen the positive impacts of placements in general practice | Letter to the editor | Fourth-year medical students at University in England | – Telephone consultations limit opportunities to elicit full histories & perform physical exams | |
– Lifestyle advice less frequently provided, restricting holistic approach to patient management | |||||
Chao, TN et al. [8] | To develop a virtual surgical rotation curriculum during COVID-19 | Implement virtual elective | Medical students enrolled in virtual Otolaryngology - Head and Neck Surgery elective at US University | – Provided direct patient contact | – Limited evaluation of medical students’ non-cognitive domains |
– One-on-one engagement with attendings & faculty | – Not a true replacement for clinic & OR experience | ||||
– Exposure to telehealth | – Limited acquisition of exam, procedural & technical skills | ||||
Chen, P et al. [9] | Determine attitudes & telehealth use in China among medical professionals & patients; identify factors affecting use | Cross-sectional study | Medical professionals, medical students & patients at 3 large hospitals in China | – 86.91% agree telehealth offered “prompt engagement in self-care” | Respondents all literate; excluded those with little education |
– 72% agree telehealth “reduces healthcare costs” | |||||
– Concerns: data reliability, privacy, fragmentation of care |
Article | Objectives | Method | Population | Major Findings | Limitations |
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de Araújo Novaes, M, et al. [3] | To improve medical student education through telehealth | Experiment field study | 9 medical students in Brazil | – High satisfaction | Data not provided |
– Enriched learning | |||||
– Increased collaboration among students, faculty & staff | |||||
– Learned skills necessary for future digital practices | |||||
Dzara, K, et al. [10] | To evaluate training, supervision & usefulness of telepsychiatry rotation | Cross-sectional study | 8 residents & 7 medical students in the USA | – 100% agree telepsychiatry enhances overall training | - Small sample size |
– 86.7% believe telepsychiatry can treat variety of conditions | – No objective pre-/post-test | ||||
– 60% had technical difficulties | – No validated survey tool | ||||
– 60% had difficulty reading patient affect | – Did not assess if didactic or clinical preparation influenced views | ||||
– 64.3% wanted more clinical experience | |||||
– 80% felt more comfortable using telepsychiatry in the future | |||||
Greisman, L., et al. [11]. | To evaluate feasibility & cost of a smartphone-based teledermatology consult service | Cross-sectional study | 2 fourth-year medical students in the USA; 93 cases evaluated by the consult service | – In 100% of cases, medical students provided enough information for diagnosis | - Small sample size |
– Students became familiar with specific management recommendations | – Limited sustainability | ||||
– Collaborative team approach | |||||
– Poor patient follow-up | |||||
– Fixed upfront cost | |||||
– Students wanted greater supervision | |||||
Heflin, KJ, et al. [12] | To describe a medical student-led initiative to provide care during COVID-19 | Editorial/Case study | 16 medical students in the USA | – Tele-health services may have improved continuity of care | Lack of access to telehealth for individuals dealing with homelessness |
– Facilitated conversations about social determinants of health | |||||
– Patients no longer wished to continue participating once health needs met | |||||
– Technical and access challenges |
Article | Objectives | Method | Population | Major Findings | Limitations |
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Himstead, AS, et al. [13]. | To determine if medical students could sufficiently use a non-mydriatic fundus camera in a teleophthalmology program | Retrospective study | Medical students participating in Floating Doctors Non-profit Org. in Panama; 126 images from 70 patients | – Most common (37.07%) photo quality was “Not ideal, but able to exclude subtle findings” | Limited results available |
– With minimal training, medical students & GPs can use remote retinal cameras to assist with diagnosis & treatment of ophthalmic conditions | |||||
Mukundan, S, Jr, et al. [19]. | To create a telemedicine system for medical students on elective study at remote locations | Experiment | 1 senior visiting British medical student; Telemedicine system between Solomon Islands & USA | – Telemedicine system provided considerable support to physicians & patients at each remote location | Full data not obtained for all referrals |
– Allowed faculty at central site to continue to supervise students abroad | |||||
Rallis, KS & AM Allen Tejerina [23] | To discuss integration & challenges of telemedicine education & training in tele-oncology | Letter | Medical students | – Suggestions: streaming tele-oncology clinics, virtual MDTs, remote access to electronic medical records | |
– Challenges: difficulty practising physical exams, empathy, motivational interviewing, patient discomfort | |||||
Schmidt, S & E Sheline [26] | To describe an telehealth coaching pilot for medical students to teach patient self-management skills | Cross-sectional study | 30+ medical students at Emory University, USA | – High learner satisfaction - impactful experiences & improved understanding of barriers patients face in accessing health care | – Small sample size |
– Positive clinical outcomes for patients - 73% of patients who attended more than one Healthy Living class lost weight | – No control group | ||||
– Selection bias |
Article | Objectives | Method | Population | Major Findings | Limitations |
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Vasquez-Cevallos, LA, et al. [28] | To present Telemedicine Platform (TMP) for rural healthcare services in Ecuado | Field study | 124 senior undergraduate medical students (63 completed questionnaire) & 6 faculty members in Ecuador; 262 teleconsultations | – Telemedicine Platform useful for learning (100%) | – Small sample size |
– Advantages: increased access to specialists, enhanced practical knowledge, assistance in diagnosis & treatment | – Different student numbers in each period | ||||
– 100% would use the platform in their rural service | |||||
– Challenges: delays by faculty in answering, connectivity problems | |||||
Wernhart, A, et al. [29] | To assess how medical students & healthcare professionals perceive eHealth & telemedicine | Cross-sectional study | 51.6% medical students in Austria | – Participants expressed moderate knowledge of eHealth & telemedicine concepts; higher levels among employees compared to students | – Self-reported data (response bias) |
– Students optimistic that telemedicine reduces healthcare costs | – Sampling limits generalizability | ||||
– Doubts if telemedicine enhances doctor-patient relationship | |||||
– Data security & privacy issues | |||||
Whittemore, MS, et al. [32] | To evaluate an insulin titration telemedicine program | Cross-sectional study | Medical students, volunteer endocrinologists & diabetes educators in the USA | – Significant decrease found between pre- & post-intervention HbA1c’s | – Limited results available |
– Further evaluation needed |
Article | Objectives | Method | Population | Major Findings | Limitations |
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Barth, J, et al. [4] | To document & identify reasons for insecurity in medical students during emergency phone consultations | Mixed methods cross-sectional cohorts | 137 fifth-year medical students from Inst of Family Medicine, Switzerland | – Students felt most insecure during history-taking due to lack of clinical knowledge & experience, urgency of call | Limited generalizability |
– Doubts about reliability of information from caller | |||||
– Lack of physical examination | |||||
Brockes, C, et al. [6] | To systematically evaluate “Clinical Telemedicine/e-Health” module over 8 years | Mixed methods prospective cohorts | Second-, third- & fourth-year medical students in Switzerland (23–35 students in various years) | – In 2015, 93% of students wanted to provide telemedicine care for chronic and older patients in their homes | – Evaluations were not performed in the same way every year |
– Increased overall satisfaction & understanding of telemedicine as a supplement in traditional medical consultations | – Number of participating students changed year-by-year | ||||
Jonas, CE, et al. [17] | To design, administer & evaluate an Introduction to Telehealth course | Cross-sectional study | 149 third-year medical students (uniformed services) in the USA | – High interest and acceptance of course | Limited generalizability (unique study pop.) |
– 10.1% increase in knowledge is modest for time invested | |||||
– 80% indicated future plans to practice telehealth | |||||
Hindman, D. J., et al. [14]. | To report on implementation of a telephone medicine curriculum (part of paediatrics clerkship) | Prospective cohort study | 245 medical students, with 67 students receiving the intervention | – Students who received the telephone medicine curriculum had significantly higher mean overall scores on simulated OSCE telephone medicine case | – Confounding - some students completed paediatrics clerkship prior to study |
– Convenience sampling | |||||
– Limited generalizability |
Article | Objectives | Method | Population | Major Findings | Limitations |
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Naik, N, et al. [20] | To develop a simulation program for video-based communication skills | Cross-sectional study | Fourth-year medical students in the USA | – Initial feedback for the course was positive | – Limited results available |
– Taught students telemedicine-specific communication skills | – Further evaluation needed | ||||
Newcomb, AB, et al. [21] | To pilot a class to improve communication skills in video consults | Cross-sectional study | 5 fourth-year medical students in a surgical internship, USA | – Felt the class introduced new skills & reinforced current ones | Small sample size limiting generalizability |
– Most reported higher self-confidence in target communication skills following the module | |||||
– Difficulty interpreting patient distress | |||||
– Poor lighting and body positioning | |||||
Rienits, H, et al. [24] | To develop a clinical skills lesson to prepare students for rural practice placements | Mixed methods cross-sectional study | 59 third-year medical students | – Improved understanding of the issues, procedures & confidence in conducting a telehealth consultation | Small sample size |
Walker, C, et al. [29] | To introduce an educational intervention to improve student knowledge and confidence with telemedicine | Cross-sectional study | 153 second-year medical students (93 completed questionnaire) | – Higher mean post-test scores in telemedicine knowledge & confidence | – Lack of objective measures |
– Most improvement in equipment operation & “designing an office conducive for a telemedicine visit” | – Low response rate | ||||
– Students want more simulation time |
Benefits of involving medical students in telemedicine
Article | Specialty |
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Abraham, H. N., et al. | Primary Care |
Berwick, K. L. and L. Applebee | Primary Care |
Bulik, R. J. and G. S. Shokar | Primary Care |
Heflin, K. J., et al. | Primary Care; Mental Health |
Knight, P., et al. | Primary Care |
Vasquez-Cevallos, L. A., et al. | Primary Care |
Whittemore, M. S., et al. | Primary Care |
Shawagfeh, A. and E. Shanina | Neurology |
Rallis, K. S. and A. M. Allen Tejerina | Oncology |
Dzara, K., et al. | Psychiatry |
Greisman, L., et al. | Dermatology |
Himstead, A. S., et al. | Ophthalmology |
Chao, T. N., et al. | Otolaryngology |