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远程医疗在急性后期/长期护理环境中监管医学生的应用。

Utilization of Telemedicine to Supervise Medical Students in the Post-Acute/Long-Term Care Setting.

机构信息

Department of Geriatric and Palliative Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.

Department of Geriatric and Palliative Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.

出版信息

J Am Med Dir Assoc. 2024 Oct;25(10):105179. doi: 10.1016/j.jamda.2024.105179. Epub 2024 Aug 3.

Abstract

OBJECTIVES

Telemedicine has become a widely accepted alternative to face-to-face patient encounters. Although there have been several peer-reviewed journal articles on incorporating telemedicine into the medical school curriculum, particularly during the COVID-19 pandemic, assessments of the effectiveness of remote supervision of medical students have not been reported. This prospective cohort study of student subjects using observational survey data evaluated the efficacy of telemedicine as an educational resource by comparing learning outcomes between osteopathic medical students receiving direct (physically present) supervision with a group who received remote (telemedicine) supervision by clinical faculty within a post-acute/long-term care (PA/LTC) setting. Learning outcomes in the domains of patient rapport, attitudes, knowledge, and behavior were measured using standardized survey instruments.

DESIGN

Prospective cohort study of student subjects using observational survey data.

SETTING AND PARTICIPANTS

A total of 167 fourth-year osteopathic medical students at a teaching nursing home (TNH).

METHODS

A total of 167 fourth-year osteopathic medical students (OMS-4s) were randomly assigned face-to-face PA/LTC patient encounters at the TNH. The encounters were follow-up visits to residents of the TNH that were supervised by faculty geriatricians. Half were accompanied by the physician and the other half were supervised by the physician through telemedicine. Evaluation using validated survey instruments measured patient rapport, verbal communication, and physical examination skills as well as attitudes, knowledge, and behaviors of the student/subjects.

RESULTS

A nonparametric statistical analysis of 4 dependent variables measuring patient rapport, attitudes, knowledge and behavior showed no significant difference between the 2 teaching modalities.

CONCLUSIONS AND IMPLICATIONS

The results of this prospective cohort study indicate that telemedicine supervision is comparable (noninferior) to direct supervision of medical student trainees in a PA/LTC setting.

摘要

目的

远程医疗已成为一种广泛接受的替代面对面医患接触的方式。虽然已经有几篇经过同行评审的医学杂志文章探讨了将远程医疗纳入医学院课程,特别是在 COVID-19 大流行期间,但远程监督医学生的效果评估尚未报道。本前瞻性队列研究使用观察性调查数据对学生进行评估,通过比较在急性后/长期护理 (PA/LTC) 环境中接受直接(面对面)监督的整骨医学学生和接受临床教师远程(远程医疗)监督的一组学生的学习成果,评估远程医疗作为教育资源的效果。使用标准化调查工具测量患者关系、态度、知识和行为等领域的学习成果。

设计

使用观察性调查数据的学生前瞻性队列研究。

地点和参与者

在教学养老院 (TNH) 共有 167 名四年级整骨医学学生。

方法

共有 167 名四年级整骨医学学生 (OMS-4s) 被随机分配在 TNH 进行面对面的 PA/LTC 患者接触。这些接触是对 TNH 居民的随访访问,由教师老年病学家监督。一半由医生陪同,另一半由医生通过远程医疗进行监督。使用经过验证的调查工具评估患者关系、口头沟通和体检技能以及学生/受试者的态度、知识和行为。

结果

对 4 个依赖变量(患者关系、态度、知识和行为)的非参数统计分析显示,两种教学模式之间没有显著差异。

结论和影响

这项前瞻性队列研究的结果表明,远程医疗监督在 PA/LTC 环境中与直接监督医学生培训生相当(非劣效)。

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