Carolinas Research Day 2021

COMMON TECHNOLOGY ISSUES ENCOUNTERED IN TELEMEDICINE STANDARDIZED PATIENT ENCOUNTERS AND THEIR PREVENTION

SIM-2

Grayson White OMS II, Rachel Burke OMS II, Tommy G. Lindsey, II, DO, FACOS* Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina

Abstract

Results

Conclusions

Introduction and Methods Background: In light of the SARS-CoV-2 Pandemic, the medical education system was faced with the challenge of how to continue teaching clinical skills under social distancing guidelines. Edward Via College of Osteopathic Medicine (VCOM) faculty responded by creating a telemedicine-like visit to provide students with an encounter that would mimic previous in-person Standardized Patient Encounters (SPEs). As more medical schools begin incorporating these telemedicine-like visits into curriculum, we highlight the technology issues experienced at VCOM to serve as a baseline for other institutions. The goal is to report on problems encountered in order to offer advice on how to avoid these issues with use in new telemedicine SPE programs. Methods: Data was collected from anonymous surveys administered on SimulationIQ to OMS I and OMS II students at all four VCOM campuses following their December SPE. The survey asked students to explain the technology issues they experienced both personally and from their Standardized Patient. A 5-point likert scale was included to identify the extent students felt the issues impacted their encounter. A frequency distribution of the reported issues was used to categorize the most frequently reported problems. Results: Out of 790 total student responses, an overwhelming majority (59.49%) reported that they did not experience any technology issues during their encounter. Of the reported issues, 60.63% reported having trouble with the augmented reality software, 32.81% reported issues with audio, 20.31% reported issues with internet connection, 15.00% reported issues with video, and 24.06% reported other unspecified issues. These students also selected how strongly they agreed to the following statement: “I experienced technology issues that affected my overall SP experience.” Of the 789 student that responded to this statement, 50.70% strongly disagreed, 13.56% somewhat disagreed, 10.90% were undecided, 19.39% somewhat agreed, and 5.45% strongly agreed. Conclusion: We identified the most common technology issues reported from the December 2020 Standardized Patient Encounters at VCOM. With these issues, we provide potential ways to mitigate experiencing these problems in future telemedicine-like encounters at VCOM and at institutions preparing to incorporate these encounters into their curriculum. Introduction: In light of the pandemic, the Department of Health and Human Services released a report detailing the usage of telehealth by Medicare patients. This report shows significant increases in the use of telemedicine visits during the height of quarantining across the United States, and while decreasing some, it is expected to remain increased after the pandemic. 1 Currently, “76 percent of U.S. hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology.” 2 With the change in the culture of provider visits, learning these telemedicine skills are equally important with learning how to conduct in-person patient visits. 3 At Edward Via College of Osteopathic Medicine (VCOM) in Spartanburg, South Carolina, faculty members recognized the unique opportunity to create a telemedicine-like visit to provide students with an encounter that would mimic previous in-person patient consults. As more medical schools begin allowing their students to learn telemedicine skills through platforms like SIMULATIONiQ TM , we highlight some of the technology problems that were experienced at VCOM-Carolinas, which can serve as a baseline for new users to create a plan in anticipation to the common problems encountered. Methods: Following the completion of the virtual Standardized Patient Encounters (SPE), OMS I and OMS II students at VCOM were asked to complete a survey about their encounters. The survey was posted on the student’s school SimulationIQ accounts and asked questions on the types of technology issues present during the encounters. Categories of the most anticipated issues encountered included: internet connection, audio/sound disfunction, camera/video difficulties, and problems with the Avatar/Augmented Reality software. In addition, the survey also evaluated how the medical students perceived the technology issues had an impact on the encounter. Survey responses were collected anonymously online, and results were evaluated using frequency distributions.

Firstly, it is important to note that the majority of student’s did not encounter technology issues during their Standardized Patient Encounter, which supports the use of telemedicine SPEs as a viable education tool. Many of the common issues encountered are best avoided by ensuring a stable internet connection is established through Wifi or through ethernet connection, and by performing sound and audio/video checks prior to beginning the encounter. For the 9.75% that encountered “other” technology issues, we evaluated the free text responses given by students on the surveys. One unexpected technology issue that arose was receiving a phone call during the encounter through the student’s Mac computers. The student’s reported having their phones off or silenced for the encounter, but they were not able to control the phone call ringing through on their computer due to the “iPhone Cellular Calls” feature. The feature is enabled by default, but students can disable this ahead of time by accessing settings on their iPhone, Cellular, Calls on Other Devices, and then disabling calls to their MacBook or other device. 4 Many students also requested the ability to practice with the technology before the actual encounters. By creating a practice module and/or SimulationIQ session, participants can log in before the SPE and ensure that their sound and audio works, ensure headphones will connect, and make sure they are comfortable using Zoom – know how to unmute, how to turn on camera, share the screen, and how to request or give remote access for the standardized patients. Throughout the COVID-19 pandemic, the use of zoom and telemedicine has undoubtedly established itself as a prominent aspect of medicine. Incorporation of telemedicine into aspects of medical education such as standardized patient encounters provides an excellent manner for students to become more acquainted with the technology before entering medical practice. However, with the adoption of new methods comes some expected challenges. By compiling the technology issues encountered by Edward Via College of Osteopathic Medicine, we hope to provide insight and troubleshoot for new programs being utilized and created at other institutions.

Figure 1 . Frequency distribution of technology issues reported by category.

References

1. Bosworth A, Ruhter J, Samson LW, Sheingold S, Taplin C, Tarazi W, and Zuckerman R, Medicare Beneficiary Use of Telehealth Visits: Early Data from the Start of COVID- 19 Pandemic. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. July 28, 2020. 2. American Hospital Association. Fact Sheet: Telehealth. Feb 2019. Web. https://www.aha.org/system/files/2019-02/fact-sheet-telehealth-2-4-19.pdf 3. Education Management Solutions. Simulation IQ Enterprise Telemedicine Data Sheet. SimulationIQ Enterprise. 2019. https://www.simulationiq.com/sites/default/files/SIMULATIONiQ_Enterprise_Tele medicine_Data_Sheet.pdf 4. Kurt, Serhat. How To Stop Your Mac From Ringing When You Get Phone Calls. MacReports. May 2019. https://macreports.com/how-to-stop-your-mac- ringing-when-you-get-phone-calls/

Figure 2 . Likert scale student responses evaluating the impact of technology issues on the standardized patient encounter.

Technology issues appeared in the following order from most frequent to least frequent: Avatar/Augmented Reality Issues (24.56%), Sound Issues (collective 13.29%), Internet Connection Issues (collective 8.23%), and Camera/Video Issues (collective 6.08%) (Figure 1). An additional 9.75% reported other issues with the encounter and were asked to elaborate with a free text response. The majority of students (59.49%) reported no technology issues occurred during their SPE. When students were asked to respond to the question “I experienced technology issues that affected my overall SP experience” with a Likert scale, 50.70% strongly disagreed and 13.56% somewhat disagreed that any technology issues present impacted their standardized patient encounter (Figure 2).

Acknowledgements

The authors would like to acknowledge Jennifer Januchowski, RN, BSN, for her assistance in circulating surveys and retrieving data from SimulationIQ.

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