International Journal of Healthcare Simulation

Background:

The COVID-19 pandemic necessitated an increase in virtual consultations with a disruption to the management of long-term conditions. Ongoing virtual consultations are required to assist with demand, patient experience and environmental impact. In both primary and secondary care, there has been no formal education provided to the workforce on how to conduct virtual consultations. Anecdotally this is affecting staff experience and well-being, patient experience and, could impact on the effectiveness of the consultation in aiding self-management. There is also an inherent risk of missed or incorrect diagnosis in virtual consultations, which could be mitigated with adequate training of the workforce.

Aim:

The training aimed to promote the development of clinical practitioners in a safe environment and to expose these participants to the key aspects of remote consultations. Additionally, the course aimed to encourage independent reflection of participant knowledge, skills, behaviour, attitudes and service quality provision in relation to simulated remote consultation scenarios.

Simulation activity outline:

We provided a combination of didactic and simulation-based education (SBE) on virtual consultations. We provided educational recordings of virtual model consultations for reference. Trainees were provided with the videos to complete a self-paced didactic educational session. Subsequently, a group session was held virtually in groups of six involving simulated clinical scenarios with a faculty-led debrief. Avatars were used to simulate patients and patient medical records were simulated in the ‘chat’ function. These simulation sessions allowed the transfer of knowledge into practice whilst using SBE methods to debrief on human factors skills, specifically focussing on human factors in a virtual world.

Method/design:

The purposely developed ‘Remote Consultation Self-Assessment Tool’ was completed immediately prior to and after the training. This tool provided Likert responses to 10 statements relating to the course content and consequent quantitative analysis was based on the percentage change in participant self-assessment. The General Self Efficacy Scale (GSE) was also used to gather information from participants prior to and after the training. The GSE measures participant self-efficacy via a 5-point Likert scale.

Implementation outline:

A total of 29 participants attended the course. There was a high failure to attend rate of 40%, with covering the COVID-19 vaccine clinics a commonly stated reason for failure to attend. Primary care workers made up 60% (n = 18) of participants, 26% (n = 9) worked in secondary care and 6% (n = 2) worked in other settings. Most participants (85%) were naive to SBE. There was a significant improvement in both the remote consultation self-assessment tool (mean difference 12.08 [95% CI 5.31 to 18.83] p = 0.001) and the GSE (mean difference 3.54 [95% CI 1.81 to 5.27] p < 0.0001). This model of delivering SBE has improved access for staff working in primary care and other areas who have not been able to access SBE previously. The use of avatars is a feasible method of delivering SBE. Consideration to improving attendance rates at courses should be a priority for those delivering SBE.