Department of General Internal Medicine/Division of Hospital Medicine & Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Med Educ Online. 2024 Dec 31;29(1):2388422. doi: 10.1080/10872981.2024.2388422. Epub 2024 Aug 6.
Telemedicine is an increasingly common form of healthcare delivery in the United States. It is unclear how there are differences in clinical performance in early learners between in-person and telemedicine encounters.
MATERIALS & METHODS: The authors conducted a single-site retrospective cohort study of 241 second-year medical students to compare performance between in-person and telemedicine standardized patient (SP) encounters. One hundred and twenty medical students in the 2020 academic year participated in a telemedicine encounter, and 121 medical students in the 2022 academic year participated in an in-person encounter. SPs completed a multi-domain performance checklist following the encounter, and the authors performed statistical analyses to compare student performance between groups.
Students who completed in-person encounters had higher mean scores in overall performance (75.2 vs. 69.7, < 0.001). They had higher scores in physical exam (83.3 vs. 50, < 0.001) and interpersonal communication domains (95 vs. 85, < 0.001) and lower scores in obtaining a history (73.3 vs. 80, = 0.0025). There was no significant difference in assessment and plan scores (50 vs. 50, = 0.96) or likelihood of appropriately promoting antibiotic stewardship (41.3% vs. 45.8%, = 0.48).
The authors identified significant differences in clinical performance between in-person and telemedicine SP encounters, indicating that educational needs may differ between clinical environments.
远程医疗是美国日益常见的医疗服务形式。目前尚不清楚在面对面和远程医疗的医患互动中,初学者的临床表现是否存在差异。
作者对 241 名二年级医学生进行了一项单站点回顾性队列研究,以比较面对面和远程医疗标准化患者(SP)就诊的学生表现。2020 学年有 120 名医学生参加了远程医疗就诊,2022 学年有 121 名医学生参加了面对面就诊。SP 在就诊后完成了一份多领域表现检查表,作者进行了统计分析以比较两组学生的表现。
完成面对面就诊的学生总体表现(75.2 比 69.7, < 0.001)更高。他们在体格检查(83.3 比 50, < 0.001)和人际沟通领域(95 比 85, < 0.001)的得分更高,在获取病史方面的得分较低(73.3 比 80, = 0.0025)。评估和计划得分(50 比 50, = 0.96)或适当促进抗生素管理的可能性(41.3%比 45.8%, = 0.48)没有显著差异。
作者发现面对面和远程医疗 SP 就诊之间的临床表现存在显著差异,这表明不同临床环境下的教育需求可能不同。