Undergraduate medical teaching with remote consultations in general practice: realist evaluation

BACKGROUND: As a result of Covid-19, students in primary care now experience patient consultations predominantly remotely, with supervisors historically educating students in face-to-face contexts. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment. AIM: To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in educational impact. DESIGN & SETTING: A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes describing how the teaching and learning functioned on a sample of medical students, and GP tutors from two UK medical schools. METHOD: An initial programme theory developed from the literature and a scoping exercise informed the data collection tools. We collected qualitative data through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (8 students, 2 tutors). The data was coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated. RESULTS: The results demonstrated a sequential style of supervision can positively impact student engagement and confidence and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and in addition, reported isolation which impacted negatively on their experiences and perceptions of primary care. CONCLUSION: Student and tutor experiences may improve through considering the supervision style adopted by tutors and interventions to reduce student isolation and disengagement when using remote patient consultations in primary care