Learning through the virtual and in-person experience: a medical student’s perspective
By Rebecca Ludden, medical student at King’s College London and Dr Koravangattu Valsraj, Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust and Honorary Senior Clinical Lecturer, Kings College London
The Covid-19 pandemic has changed the way healthcare is delivered across the NHS. Virtual consultations, meetings and ward rounds have become more commonplace in clinical practice to accommodate social distancing, working from home and shielding. In the two years since the UK first went into lockdown, a blended approach has been implemented across healthcare services, sometimes with sub-optimal outcomes.
A psychiatric ward round enables professionals, patients, family members and carers to discuss progress and clarify care management plans. During placements in the Psychiatric Intensive Care Unit (PICU) at the Bethlem Royal Hospital, medical students experienced in-person ward rounds, as well as those held online.
An online ward round can pose immense challenges when attempting to assess a patient’s mental state. It is limited by camera and microphone quality, as well as internet strength and reliability.
If a patient struggles to engage in a conversation with someone on the video call, the assessor must question whether this is due to extraneous factors, or due to their symptoms. Therefore, an online format has the potential to introduce more variables into the assessment, which makes drawing a conclusion, formulating a management plan and leading patient care, more difficult.
Online meetings remove a large portion of non-verbal communication cues from the social interaction and creates difficulty for both patients and healthcare professionals. However, when alone in a room and on a video call, it has meant those meetings could go ahead without wearing a mask.
When attending the ward round virtually, students were tasked with performing a mental state examination based on the patient’s on-screen interactions with those colleagues in the meeting room. This was challenging, as it was not easy to comment definitively on the appearance of the patient and it was also difficult to recognise whether the patient was making eye contact with those in the room. The format of online ward rounds meant it was not always possible for students to complete the mental state examination in full. That said, with the good fortune of a stable internet connection, students could complete other aspects of the examination - such as speech, thought form and insight - but this too could have its own challenges.
Virtual ward rounds did present opportunities to participate and learn, allowed for social distancing without needing to reduce the number of professionals and family members in a room, and meant less time was lost from travelling or being unable to attend placements physically. It also allowed patients’ family members to attend, including those living abroad, which was welcomed for the potential to improve the therapeutic experience and deliver better overall outcomes for the patients concerned.
From a student perspective, the flexibility of online learning was and is welcome, but the immersive learning experience is best achieved through being present, in-person. The significant benefits of being on-site and in person had not been fully appreciated until the pandemic forced students into a full year of online learning. In medicine, nothing can match the in-person immersive leadership learning experience of being in the same room as patients themselves.