Good for patients but not learners? Exploring faculty and learner virtual care integration

Abstract

Background: The pandemic catapulted the adoption of virtual care far ahead of its anticipated maturation date, forcing faculty to role model and teach learners with barely enough time to master it themselves. With a scant body of prepandemic literature now accompanied by experience gained under extraordinary circumstances, we can benefit from understanding ad hoc strategies implemented by those on the front lines and from listening to learners about what is working and what is not. The purpose of this study was to explore the experience of learner integration into virtual care from both the faculty and learner perspectives.Methods: Using a constructivist grounded theory methodology and sociomateriality as a sensitising concept, we recruited participants using purposeful and theoretical sampling from a Canadian University with limited prepandemic virtual care provision.We interviewed 16 faculty and 5 learners spanning a breadth of specialties and years of practice/education to probe their experience of teaching and learning virtual care.Data collection and analysis were conducted iteratively with themes identified through constant comparative analysis.Results: Integrating learners into virtual care proved challenging initially because of a lack of familiarity with the process and later because of disrupted workflow, triggered by the structure and logistics of the virtual care clinic. Both faculty and learners identified learning deficiencies in the virtual care experience when compared with inperson clinics, but several unique and valuable learning affordances were noted. All faculty expressed a desire to keep virtual care as part of their future clinic practice, but paradoxically most felt that they were unlikely to include learners. Conclusions:Training learners in virtual care is an educational challenge that will not disappear with COVID-19, even if our participants wished it could. The perceived value for patients but not learners begs a reconsideration of the sociomaterial contribution to this pandemic paradox.

Exploring the educational value of the general surgical outpatient clinic: a systematic review

“…Telehealth itself is now proposed to be an important competency for the next generation of clinicians; therefore, engagement at a junior level is critical [ 25 ]. Despite this, there is a perception that telehealth limits learner participation [ 26 ]. As this review highlights the utility of the learning only in the face-to-face outpatient setting, further research examining the means by which surgical learners can be incorporated into telehealth consultations or interventions which improve learning for those engaging in surgical outpatient telehealth consultations is advised.…”

Virtual care is growing, but who will train upcoming learners to practice it?

“…the fit between perceptions of effective physician leadership and the character-based models of leadership that have been generated in other domains. 1 The authors highlight that debate about the competencies required for leadership persists despite widespread acknowledgement that leadership is important to medicine and, thus, needs to be taught in medical schools. Most of that teaching, they argue, focuses on cognitive competencies that are necessary but insufficient.…”

“…The findings reported in the paper suggest that character-based leadership, a conceptual framework that articulates a role for various dimensions of character when defining effective leadership, can help medical education move beyond models that solely promote cognitive competencies. 1 In this commentary, we attempt to expand upon this particular work by outlining a variety of other models and issues that we as a field would do well to take into account.…”

“…In this issue of Medical Education, Shepherd and colleagues report on their qualitative exploration of how faculty and learners experience learner integration into virtual care (VC). 1 This provocative study raises questions into the paradox and contradiction of faculty and learner VC integration, and invites further reflection and discussion. Given the inevitable adoption of VC following the COVID‐19 pandemic, and the subsequent hasty efforts to accommodate learners, the work could not be more well‐timed.…”

“…In this issue of Medical Education, Shepherd and colleagues report on their qualitative exploration of how faculty and learners experience learner integration into virtual care (VC) 1 . This provocative study raises questions into the paradox and contradiction of faculty and learner VC integration, and invites further reflection and discussion.…”