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From Screen to Skills: Preparing Medical Students for Telemedicine Practice

A multimodal telemedicine curriculum significantly improved pre-clerkship medical students' confidence in core virtual care competencies, with the greatest gains observed in those who participated in an additional interactive workshop, though confidence levels declined slightly by the one-year follow-up.

Original authors: Elizabeth Burgess, Amanda Jagolino-Cole, Allison Ownby, Mark Hormann, Shivika Chandra

Published 2026-07-08

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Elizabeth Burgess, Amanda Jagolino-Cole, Allison Ownby, Mark Hormann, Shivika Chandra

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine medical school as a long journey where students first learn the theory of driving (pre-clerkship) before they are allowed to get behind the wheel and drive real patients (clinical clerkships). For a long time, the "driving school" didn't teach much about driving a car that doesn't physically exist—a telemedicine car, where the doctor and patient are miles apart, connected only by a screen.

This paper is like a report card on a new "driving simulator" the school built to fix that gap. Here is the breakdown of what they did and what they found, using simple analogies:

The Problem: Driving Blindfolded

Before this study, many medical students were graduating and heading into their real-world rotations without ever having practiced "virtual driving." They knew how to talk to a patient in a room, but they felt shaky about talking to one through a computer, fixing a frozen screen, or writing notes for a visit that never happened in person. It was like sending a pilot into the sky without ever having flown in a simulator.

The Solution: A Two-Part Training Camp

The researchers at UTHealth Houston built a training program for second-year students (just before they start seeing real patients) to teach them how to drive this "virtual car." They used a multimodal approach, which is like learning to drive in two stages:

The Video Lessons (Asynchronous Modules): Every student (238 of them) had to watch online videos and complete digital lessons. This was the "textbook" part of learning the rules of the road.
The Driving Simulator (Interactive Workshop): A smaller group (15 students) chose to sign up for an extra, hands-on session. Here, they practiced talking to "actors" (standardized patients) via video, trying to fix fake tech glitches, and getting real-time feedback. This was the "behind-the-wheel" practice.

The Test: How Confident Did They Feel?

The researchers asked the students to rate their confidence on a scale of 1 to 4 (from "I have no idea what I'm doing" to "I'm an expert") in nine different skills, like:

Navigating the software.
Doing a physical exam through a camera.
Fixing tech problems.
Writing the medical notes.

They tested the students at different times: before the training, after the videos, after the workshop, and even one year later.

The Results: The Training Worked

Here is what the data showed, using our driving analogy:

The "No Training" Group: Students who didn't get this special training stayed at the same low level of confidence. They were still unsure how to drive the virtual car.
The "Video Lessons" Group: After just watching the online modules, the students' confidence jumped up significantly. They went from feeling shaky to feeling "moderately confident." It was like reading the manual helped them understand the dashboard.
The "Workshop" Group: The students who did the extra hands-on practice felt the most confident. They were the highest of all groups. It proved that practicing with a "simulator" (the actors) made them feel much more ready than just watching videos.
The "One Year Later" Check: When the researchers checked back a year later, the students were still more confident than they were before the training started, but their confidence had dipped a little bit. It's like how you might forget a few details of how to park a car if you haven't driven in a year, but you still remember how to drive better than someone who never took a lesson.

The "Self-Selection" Twist

There was a funny thing about the students who signed up for the extra workshop. Before they started the workshop, they actually felt less confident than the students who just did the videos. It seems the students who felt they needed extra help were the ones who raised their hands to get it. This is like a student who feels bad at math signing up for extra tutoring, while the students who feel they already know the material just stick to the regular class.

The Bottom Line

The paper concludes that you don't need a year-long course to teach medical students how to do telemedicine. A short, structured mix of online lessons and hands-on practice is enough to make them feel much more ready to treat patients virtually.

The authors say this training bridges the gap between "learning the theory" and "doing the job." However, they are careful to note that they only measured how confident the students felt, not whether they actually became better doctors or if their patients got better care. They proved the students felt ready; they didn't prove the patients were cured, but they believe this is the essential first step.

In short: They built a small, effective "virtual driving school" for future doctors, and it successfully stopped them from feeling lost when they finally had to drive the virtual car.

Technical Summary: From Screen to Skills: Preparing Medical Students for Telemedicine Practice

Problem Statement
The rapid expansion of telemedicine, accelerated by the COVID-19 pandemic, has reshaped healthcare delivery, yet formal training in telemedicine remains limited within medical school curricula. Prior to this study, only a minority of U.S. medical schools offered structured telehealth curricula, leaving many students unprepared for virtual care during clinical clerkships. While the American Medical Association (2016) identified telemedicine as a core competency, significant gaps persisted regarding standardized content, robust skill assessment, and early hands-on training. Consequently, pre-clerkship students often lacked the foundational skills necessary to navigate platforms, perform virtual examinations, and troubleshoot technical issues before entering clinical rotations.

Methodology
The authors employed a Plan-Do-Study-Act (PDSA) framework and Kern's Six-Step Approach to design and implement a multimodal telemedicine curriculum at UTHealth Houston McGovern Medical School. The study focused on second-year medical students (pre-clerkship) during their Transition to Clerkship (TTC) phase.

Curriculum Structure: The intervention consisted of two components:
1. Mandatory Asynchronous Modules: Web-based learning covering core competencies (platform navigation, virtual exams, documentation, and troubleshooting).
2. Optional Interactive Workshop: A session featuring standardized patient encounters for real-time feedback and skill practice.
Study Groups: Participants were categorized into six groups based on intervention timing and type:
- No Intervention Group: Control group (Class of 2023) with no formal telemedicine curriculum.
- Pre-Modules Group: Baseline measurement (Class of 2025).
- Post-Modules Group: After completing asynchronous modules.
- Pre-Workshop Group: After modules but before the optional workshop.
- Post-Workshop Group: After completing the optional workshop.
- 1-Year Follow-Up Group: Assessment one year later (beginning of MS4).
Data Collection: Self-reported confidence was measured using a 4-point Likert scale across nine specific telemedicine competencies (e.g., navigating platforms, establishing rapport, performing focused exams, troubleshooting technology).
Statistical Analysis: Data were analyzed using one-way ANOVA and Tukey's Honest Significant Difference (HSD) tests to compare group differences. Effect sizes were calculated using partial eta-squared ( $\eta_p^2$ ).

Key Contributions
The paper presents a structured, multimodal curriculum designed to bridge the gap between pre-clerkship education and clinical telemedicine demands. Key contributions include:

Early Exposure: Implementing standardized telemedicine training prior to clinical clerkships, ensuring all students acquire core skills before encountering virtual care in practice.
Multimodal Approach: Combining mandatory asynchronous learning with optional experiential workshops to address varying learner needs and confidence levels.
Longitudinal Assessment: Evaluating confidence retention over a one-year period, providing data on the durability of the intervention's effects.
Competency Mapping: Explicitly targeting nine specific competencies aligned with broader educational goals, including technical troubleshooting and documentation.

Results

Participation: 238 students (100% of the Class of 2025) completed the mandatory modules. Only 15 students (6%) opted for the additional interactive workshop.
Confidence Gains: A one-way ANOVA revealed significant differences in confidence across the six groups ( $F(5, 6258) = 340, p < .001$ $F (5, 6258) = 340, p < .001$ ).
- Confidence increased significantly from baseline (Pre-Modules: $M = 2.14 \pm 0.87$ ) to post-modules (Post-Modules: $M = 3.02 \pm 0.71$ ).
- The highest confidence was observed in the Post-Workshop group ( $M = 3.59 \pm 0.59$ ).
- The Pre-Workshop group ( $M = 2.63 \pm 0.64$ ) showed lower confidence than the Post-Modules group, suggesting self-selection bias where students with lower confidence sought the additional workshop.
Specific Competencies: The largest gains were observed in performing focused examinations, troubleshooting technology, and documentation (improvements of approximately 50–60%). Smaller gains were noted in history-taking and rapport-building, areas where baseline confidence was already higher.
Longitudinal Retention: At the one-year follow-up, confidence levels remained above baseline ( $M = 2.36 \pm 0.97$ vs. baseline $2.14$) but declined from immediate post-intervention levels, indicating partial regression over time.
Control Group Validation: The No Intervention Group maintained baseline confidence ( $M = 2.14 \pm 0.95$ ), confirming that the observed gains in the intervention groups were due to the curriculum rather than natural progression.

Significance and Claims
The authors claim that a brief, structured, multimodal telemedicine curriculum effectively improves pre-clerkship students' confidence across multiple core competencies. The study suggests that integrating such training longitudinally can enhance preparedness for virtual care and bridge the gap between pre-clinical education and clinical demands.

The paper modestly frames its findings as an essential first step (Kirkpatrick Level 1: learner reaction) toward preparing physicians for safe virtual care. It acknowledges limitations, including the reliance on self-reported confidence rather than objective performance assessments, the small sample size for the optional workshop, and the single-institution setting. The authors conclude that while the curriculum establishes a necessary foundation, sustained curricular incorporation and future work involving objective skill assessments and multi-institutional studies are required to fully address the evolving landscape of telemedicine education.