What your doctor is reading on Medscape.com:
MAY 08, 2020 — The garbage trucks outside my window are so loud that I can’t hear what the “patient” is saying. I try to obtain a medical history but soon give up. I switch to the physical examination. I know how to do this in person, but how do I do this over a computer? Before I know it, my allotted time runs out.
A proctor directs me to a virtual portal that contains a note template I’ve never seen before. I waste precious minutes trying to decipher it. Time runs out for this portion too. I’ve produced an incomplete note. This was a “less than optimal” patient visit. Actually, it was a total disaster. The virtual Objective Structured Clinical Examination (OSCE), my first real telemedicine experience, was a complete train wreck.
Virtual exams are becoming the new norm during the COVID-19 pandemic. The struggles I had with the virtual OSCE showed me that telemedicine is not as simple as having a Zoom chat with a patient. Just like any specialty requires specific training, telemedicine requires appropriate preparation. Until now, that is training and preparation that many of us medical students haven’t had.
The COVID-19 pandemic is almost certainly going to lead to medical schools introducing telemedicine earlier in training. Here’s what taking the virtual OSCE taught me that we need.
What I Wish I Had Been Taught
Teaching telemedicine and related skills to students doesn’t need to be radically different from training courses already available to practicing clinicians, such as the one offered by Thomas Jefferson University. The difference is that by introducing that material earlier in medical training, students could learn traditional and virtual approaches simultaneously. This would obviously allow for a better, deeper understanding of both. Presenting content in multiple formats often helps us truly learn something. For example, I didn’t fully comprehend the concept of pulmonary hypertension from just hearing about it in lectures. I only “got it” when I actually saw it in a patient.
In fact, learning a new approach like virtual examinations may help solidify older, traditional clinical skills. We medical students currently learn to take a patient history through in-person classes that incorporate a physical examination, note writing, and other basics. Conducting virtual visits would be an excellent way to solidify our history-taking skills and reiterate their importance. Being challenged to arrive at a diagnosis solely through a patient history obtained during a virtual visit would be a strong test of clinical acumen.
Continued
In terms of virtual assessments, I struggled with how to adapt the typical methods of examination—listening to the heart and lungs, palpating the abdomen—in a nonphysical environment. In a virtual OSCE exam, medical students are expected to verbally describe examination maneuvers. Just as how the best quarterback in the NFL may not be able to describe exactly how he throws a football, a great medical student may not be able to describe how to listen for a carotid bruit or tracheal breath sounds.
If virtual exams are expected to be accurate assessments of our clinical abilities, students require training on how to verbalize physical examination maneuvers. For example, during my exam, I wanted to assess for signs of end organ damage (like retinopathy) in a patient with diabetes. Without a funduscope, and looking through a computer screen, I wasn’t able to assess his eyes for hypertensive damage. I wasted precious time thinking about ways I could check for any retinal irregularities.
Another challenge for me was the patient note portion of the virtual OSCE. During my exam, the portal where we recorded our patient notes was not available during the “history and physical” portion. I was forced to write my notes in a Word document. This made it very difficult to input the information into the portal later on and wasted precious time.