Al-Bedaery Roaa, Chaudhry Umar Ahmed Riaz, Jones Melvyn, Noble Lorraine, Ibison Judith
Institute of Medical & Biomedical Education, St George's, University of London, Cranmer Terrace, London, UK
Population Health Research Institute (PHRI), St George's University of London (SGUL), University of London, Cranmer Terrace, London, UK.
BJGP Open. 2022 Sep 28;6(3). doi: 10.3399/BJGPO.2021.0185. Print 2022 Sep.
Supervisors historically educated students in primary care in face-to-face contexts; as a result of COVID-19, students now experience patient consultations predominantly remotely. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment.
To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in terms of educational impact.
DESIGN & SETTING: A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes, describing how the teaching and learning functioned on a sample of medical students and GP tutors from two medical schools in London, UK.
An initial programme theory was developed from the literature and a scoping exercise informed the data collection tools. Qualitative data were collected through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (eight students, two tutors). The data were coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated.
The results demonstrated a sequential style of supervision can positively impact student engagement and confidence, and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and, in addition, reported isolation that impacted negatively on their experiences and perceptions of primary care.
Student and tutor experiences may improve through considering the supervision style adopted by tutors, and through interventions to reduce student isolation and disengagement when using remote patient consultations in primary care.
以往，导师在面对面的情境中对初级保健专业的学生进行教学；由于新冠疫情，学生现在主要通过远程方式进行患者咨询。关于在远程咨询环境中促进或阻碍对学生进行有效教学监督的因素，目前证据不足。
了解在初级保健中使用远程咨询对医学生进行教学的促进因素和障碍，以及对学生教育影响方面的后果。
采用现实主义评价方法来确定背景、机制和结果的因果链，描述在英国伦敦两所医学院的一组医学生和全科医生导师中，教学是如何开展的。
根据文献制定初步的项目理论，并通过范围界定活动确定数据收集工具。通过在线问卷（49名学生、19名导师）和/或半结构化访谈（8名学生、2名导师）收集定性数据。对数据进行编码，以生成背景-机制-结果配置，概述教学是如何运作的。
结果表明，循序渐进的监督方式可以对学生的参与度和信心产生积极影响，并强调需要让学生为远程患者检查做好准备。学生们发现被动观察远程患者会诊会让他们失去参与感，此外，他们还表示这种孤立状态对他们对初级保健的体验和认知产生了负面影响。
通过考虑导师采用的监督方式，以及采取干预措施减少学生在初级保健中使用远程患者咨询时的孤立感和脱离感，学生和导师的体验可能会得到改善。
