Exploring trainee’s perceptions of virtual consultations

Introduction: In 2020 the COVID-19 pandemic accelerated virtual consultation use across the world. Although levels of virtual consultations have reduced there is ongoing drive to continue with such consultations and they are likely to continue to account for a large proportion of consultations both in primary and secondary care. Given the rise of these virtual consultations across the NHS, this research sought to explore the effect of these consultations on postgraduate medical trainees, aiming to explore their perceptions of undertaking such virtual consultations and how the rise of such consultations may impact on postgraduate training. Methods: Participants chosen were current medical doctors all working at registrar level who were currently or who had recently (within the last year) undertaken virtual outpatient clinics or consultations. Semi-structured interviews of the participants were undertaken and we utilised a phenomenological approach to explore the participants lived experiences of undertaking these consultations. Analysis of the data was inductive using a thematic approach. Coding was completed on NVivo with an iterative coding approach maintaining reflexivity throughout. Results and Discussion: Three main themes emerged from the data: ‘The Consultation’, ‘The Clinician’ and ‘The Patient’. The virtual consultation was shown to require a differing approach from a face-to-face consultation with participants highlighting the importance of a clear introduction and structure. This is a consideration which has been echoed in many consultation models but appears to be even more vital in a virtual setting. Clinicians need to be aware of the need for a clear introduction which sets the scene for an open consultation where the patient can freely express their concerns. Participants also noted the effect of the virtual medium on the doctor-patient relationship and how this can affect the consultation, with concerns that we may miss the patient’s hidden agenda or ‘secondary problems’. Awareness of this issue and allowing the patient multiple opportunities to discuss their concerns as well as considering the psychosocial impact and involving family where appropriate can help to mitigate these factors. The second theme was ‘The Clinician’; participants spoke about how the lack of visual cues and reassurances could lead to uncertainty and anxiety around management and possibility of missed diagnoses. The participants noted that being able to ‘eyeball’ a patient can give reassurance not only if the patient is well but also allows the clinician to rapidly assess if they are acutely unwell and may need immediate medical attention, assessment via telephone is much more difficult and as such there must be robust systems in place to allow patients to be reviewed face-to- face if required. Participants also spoke about the effect of virtual consultations on supervision and the increasing use of remote supervision. The rise in remote supervision may be appropriate but must be an individualised approach, considering the seniority of the trainee, as to whether indirect supervision remotely is appropriate. The final theme was that of ‘The Patient’ which discussed how virtual consultations may not be appropriate for all patients and how it may unnecessarily disadvantage certain groups of patients, this is an important key consideration for all organisations undertaking such consultations and we need to ensure that we do not disadvantage these patients or delay their care unnecessarily due to these issues. Conclusion: This project has shown that there are key differences between virtual consultations and face-to-face consultations which need to be further considered to allow us to effectively teach these consultation skills to future clinicians, ensuring that the consultation is effective and beneficial both for the clinician and the patient.