Richard Smith: Medical schools shift to teaching online consultation with patients


As with everyone and every organization, the covid-19 pandemic has presented challenges, but also opportunities, to medical schools. One challenge is how schools can ensure adequate and safe contact with patients, especially for students in their early years. The answer, as with so many others, is to offer online contact, and this is where the opportunity lies as these young students will be practicing in a world where many, if not most, consultations will take place online. line. During the pandemic, all general practice consultations with patients were initially online or by phone, and the president of the Royal College of General Practitioners suggested that half of all consultations could be done by phone or online in the future. Likewise, a high proportion of outpatient consultations have been and will be carried out online or by telephone.

Patients know best (which I chair and in which I have own funds) is a company founded on the idea that patients should control all their medical and social records, receive results online as soon as they are available, be able to communicate electronically with health professionals caring for them, and making the change in their health and health care. We believe – and more and more everyone agrees – that this is how health care will inevitably develop. It is therefore quite logical that medical students, who will practice until 2070, are trained in such an environment.

The Leicester Medical School experience

Leicester Medical School was the first to recognize this and I wrote about the program they developed in 2014. The freshmen were divided into groups of eight and given fictitious patients to communicate with online using software developed by Patients Know Best. The goals were to give freshmen safe contact with a variety of patients (many from ethnic minorities) with a variety of problems, but particularly long-term conditions. By 2017, when I returned to Leicester, the medical school had started using real patients, and both patients and students enjoyed the experience, although they recognized that face-to-face consultations would still have a important role.

The Pharmacy Schools at Aston University and Johns Moore University in Liverpool, the De Montfort University School of Nursing and the City University School of Midwifery have all used the program in various ways. shapes. One of the advantages has been to encourage multidisciplinary learning, which is essential but has proved difficult to implement. City University used the program to introduce students to patients with complex health and ethics issues; students stay with patients long term and can contribute to their care and grades.

With the pandemic, online education is spreading: three models

Although various medical schools have expressed interest in the program, which Patients Know Best offers free of charge, no other medical school has launched a program. But then came the covid-19 pandemic and medical schools recognized that online counseling was going to be an essential skill for students to learn and that such counseling could ensure that students could have safe contact with patients. . Sarah Wright, a former scholar who now works for Patients Know Best, presented the program to the UK Council for Clinical Communication, and 12 of the 36 UK medical schools have expressed interest in joining the program.

Patients Know Best’s software has developed many other features since it was first used for education in Leicester, and the experience of Leicester and other schools has taught us a lot. In addition, Patients Know Best now has contacts to provide services to 12 million people in Britain. We now offer three standard models that can be easily implemented for schools of healthcare professionals. Each school can adapt the models to its own requirements.

In the simplest “simulated” model, the school uses fictitious patients with fictitious records. This is the model initially used in Leicester, and the team created a collection of fictitious patients, with different names, demographics, illnesses, medications, and allergies. There is obviously great potential for universities to both expand and share collections of fictitious patients. A few volunteers can then interact with the students and the files.

The second “hybrid” model uses real patients but fictitious records. Many patients are only too happy to interact with students, and these interactions can last for years. The Leicester students interacted, for example, with a woman who suffered from several long-term health issues who also had a son with long-term health issues and another woman with a chromosomal disorder. Students learned a lot from patients about their experiences with professionals, not all of which were positive. Using records created for educational purposes avoids information governance issues that might otherwise cause difficulties. Medical schools can find patients, but so can Patients Know Best, which now has hundreds of thousands of patients checking their charts. (Indeed, if the readers of this article wish to volunteer, fill out the form here:

The third model uses real patients and real records and means that information governance issues must be overcome. Most medical schools go with the first or second model in hopes of developing real patients with real records, but Cambridge Medical School is planning a pilot project with real patients and real records.

Accompaniment of the sick

In addition to learning from patients, students can provide support to patients. We have all heard the stories of covid-19 patients sick and even dying in intensive care units without any face-to-face visits from family and friends. An intensive care clinician at University Hospital of Wales believes giving patients access to students through Patients Know Best could provide both rich learning for students and support for patients. Students can also, if the patient agrees, communicate with families, bringing them knowledge and reassurance. (Patients decide who has access to their records, and many patients can grant access to other family members.) This system must also overcome information governance issues. (It should be noted that in some places concerns about information governance have been set aside to respond quickly to the pandemic.)

Bristol Medical School has 270 patients per year, and typically new students are connected through general practice practices in a one-patient group. The goal now is to achieve this through Patients Know Best, and the school needs two patients from each of the approximately 50 practices. So far, 25 have accepted.

While Patients Know Best provides all of these services for free, there are costs associated with the business. We have tried to standardize the processes to keep costs to a minimum. Nevertheless, models should be explained, contracts negotiated, software installed and supported, and staff and students should be trained in the use of Patients Know Best. Students are, of course, “digital natives” and find the software easy to use and need little training. Sarah Wright has devoted a considerable amount of her time to the project, but enjoys interacting with staff and students and watching the different models emerge. The company is planning to appoint a new staff member to administer the program, and with any luck we may be able to find sponsorship for the position. Patients Know Best, of course, benefits as the next generation of healthcare professionals become familiar with their software.


The Leicester team struggled to find funds for a full assessment, but held focus groups with staff, students and patients and published their results. Their conclusions are that students adapt quickly to technology and behave in a professional manner when communicate with patients online. The permanent online recording of interactions, provided by Patients Know Best, is invaluable in providing feedback to students on their counseling skills, and the interactions provide a realistic test of student knowledge.

But, the Leicester team concluded, “more work is needed to identify the key skills required to communicate effectively with patients in this way.” With so many professional health schools starting to use online counseling for education, and so many skilled professionals doing so every day, we should move forward quickly in identifying skills and how to teach them.

Richard smith was the editor-in-chief of BMJ until 2004.

Competing interest: RS has been the unpaid chairman of Patients Know Best since the company was founded 11 years ago, but owns equity (approximately 1% of the shares) in the company.


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