Are remote clinical assessments a feasible and acceptable method of assessment? A systematic review.

The COVID-19 pandemic presented an enormous and immediate challenge to assessing clinical skills in healthcare professionals. Many institutions were unable to deliver established face-to-face assessment methods such as Objective Structured Clinical Examinations (OSCEs). Assessors needed to rapidly institute alternative assessment methods to ensure that candidates met the clinical competences required for progression. Using a systematic review, we aimed to evaluate the feasibility, and acceptability of remote methods of clinical skills assessment, including remote structured clinical assessments and the submission of video recordings. We searched for studies reporting on Remote Clinical Assessments or its variants in MEDLINE, Embase and The Cochrane library from 2000 to March 2021. Twenty eight studies were included in the review; 20 studies related to remote structured clinical examinations or OSCEs and 8 reported the use of video submissions. The participants of the different studies included medical students, nursing students, dental students and doctors in training. A variety of different online platforms were utilised including Zoom, Skype, webcams, and Adobe Connect online. The studies found that delivery of remote clinical assessments is possible and provides an alternative method of assessing many clinical skills, but most also acknowledge limitations and challenges. They are acceptable to both candidates and examiners, and where measured, show moderate agreement with on-site clinical assessments. Current evidence is based on studies with low methodological quality and for the most part, small sample sizes.

Modern slavery response and recognition training.

BACKGROUND: Modern slavery is the recruitment and movement of people by force, coercion, deception or abuse of vulnerability for the purposes of exploitation. Modern slavery is a serious violation of human rights with significant negative physical and mental health consequences. Health care professionals are in a unique position to identify, safeguard, make appropriate referrals and meet the health needs of victims of such exploitation when they access health care. Moreover, there are significant legal, professional and ethical obligations for health care professionals regarding responding to modern slavery. METHODS: We designed a two-part teaching session for undergraduate medical students at Cardiff University. Part 1 provided students with sufficient content information regarding the different types of modern slavery and pathways of referral. Part 2 provided training for students to communicate safely and effectively with these vulnerable patients. Student evaluation data were collected following the teaching. RESULTS: Quantitative and free text analysis confirmed that student confidence in recognising and understanding the action expected of them improved significantly following the teaching. DISCUSSION: Recent research indicates a serious shortfall in knowledge and confidence amongst health care professionals in the UK. Undergraduate medical education is a strategic point for training regarding people trafficking, yet medical education on people trafficking is variable and often absent in the UK. Although challenging in terms of content and governance, this teaching innovation appeared to be successful in raising the students' awareness of an increasingly common problem in the UK, helping to equip students with the necessary knowledge and skills to effectively identify and safely manage consultations involving potential victims of modern slavery.

Teaching pediatric communication skills to medical students.

BACKGROUND: Delivering effective clinical pediatric communication skills training to undergraduate medical students is a distinct and important challenge. Pediatric-specific communication skills teaching is complex and under-researched. We report on the development of a scenario-based pediatric clinical communication skills program as well as students' assessment of this module. METHODS: We designed a pediatric clinical communication skills program and delivered it five times during one academic year via small-group teaching. Students were asked to score the workshop in eight domains (learning objectives, complexity, interest, competencies, confidence, tutors, feedback, and discussion) using 5-point Likert scales, along with free text comments that were grouped and analyzed thematically, identifying both the strengths of the workshop and changes suggested to improve future delivery. RESULTS: Two hundred and twenty-one of 275 (80%) student feedback forms were returned. Ninety-six percent of students' comments were positive or very positive, highlighting themes such as the timing of teaching, relevance, group sizes, and the use of actors, tutors, and clinical scenarios. CONCLUSION: Scenario-based teaching of clinical communication skills is positively received by students. Studies need to demonstrate an impact on practice, performance, development, and sustainability of communications training.

Unwrapping the diagnosis of tuberculosis in primary care: a qualitative study.

BACKGROUND: Although tuberculosis (TB) is relatively rare in the UK, its diagnosis is important because diagnostic delays can result in worse outcomes for patients and expose others to the risk of infection. Atypical presentations may be common, and patients' help-seeking behaviour may influence the diagnostic process in primary care. Little is known about the process of diagnosing TB in primary care in developed countries. AIM: To understand the process of diagnosing TB in UK primary care. DESIGN OF STUDY: Qualitative inductive study with paired semi-structured interviews. SETTING: Communities and general practices in south-east Wales. METHOD: Interviews were conducted with 17 patients diagnosed with TB in the previous 6 months and 16 GPs involved with their care. Data were analysed thematically. RESULTS: In response to expected classical features, GPs generally ordered specific tests. Both GPs and patients reported atypical presentations, and then the diagnostic and referral net was appropriately widened in most cases. Identified barriers to prompt diagnosis included atypical presentations and low clinical suspicion of TB, lack of continuity of care, workload demands that limit time with patients, and suboptimal clinician-patient communication. GPs recognised the growing problem of TB nationally and the need for improved education among health professionals. CONCLUSION: GPs' and patients' accounts about the process of diagnosing TB suggest that delays can occur, although they are not typical. Where diagnosis is clear, GPs generally test specifically and refer appropriately; where diagnosis is less clear, the diagnostic net is cast further. It is only when certain core values of general practice are not applied (including continuity of care, considering context appropriately, and eliciting and responding appropriately to patients' explanatory models) that clinicians and patients identify a suboptimal diagnostic process.