Table 2.

Selected examples from medical student performance on two telehealth OSCE stations for chronic and acute conditions: proficiency and representative faculty comments.

Objective structured clinical evaluation	Faculty ratings		Representative faculty feedback (open-ended responses)
Clinical focus	Done	Needs improvement	Done	Needs improvement
Case 1: diabetes mellitus
Appears professional: attire/background	113 (93%)	8 (7%)	“We appreciate that you wore your white coat, which created a very professional first impression”	“Unmade bed was visible in the background: this can decrease the professionalism in your encounter”
Assists patient with technology as needed: camera/audio/lighting	102 (83%)	21 (17%)	“Navigated patient through unmute button”	“Could try to help her find the mute button by giving her instructions”
Confirms confidentiality: location/participants	26 (21%)	97 (79%)	“Done”	“Over telehealth, it is important to ask who else may be in the room or part of the visit”
Establishes mutual goals/agenda for the visit	104 (86%)	17 (14%)	“Skillfully navigated multiple concerns and established patient's priorities”	“One way to do this is: ‘Is there anything else you want to make sure we reviewed?”'
Reviews limitations of visit and obtains consent	42 (35%)	78 (65%)	“Excellent-most students don't do this!”	“Recommend reviewing potential limitations and obtaining consent to move forward”
Establish initial rapport	122 (99.2%)	1 (0.8%)	“Diffused patient's frustration with tech and built rapport readily”	“Consider spending a little more time in the beginning investing in the relationship by connecting to the patient in some way.”
Eye contact: enough to build a connection with the patient and verbalize off-screen activities (taking notes, reviewing chart)	117 (95%)	6 (5%)	“<Student name> explained that she will be taking notes during the encounter, explaining off-screen activities”	“Eye contact was angled downward and to your left; we would recommend moving the patient's video closer to your computer's camera”
Uses tone/pace and posture, showing care and concern	119 (98%)	3 (2%)	“Well-paced and caring tone of voice”	“We'd recommend slowing down the pace of speech or pausing periodically”
Pays attention to verbal and non-verbal cues	119 (97%)	4 (3%)	“<Student name> was attuned to the patient's facial expression and clarified when the patient seemed confused”	“Could have responded a bit more fully to the ‘chief concern' about his father's health”
Elicits and addresses emotional content	108 (90%)	12 (10%)	“Excellent response to patient explaining multiple stressors”	“We would recommend exploring the patient's life situation and how these challenges pose an obstacle for behavior modification”
Case 2: low back pain
Evaluated range of motion	39 (86.67%)	6 (13.33%)	“<Student> had patient turn sideways to assess flexion/extension: this provided a much better angle”	“Better to do this with patient standing rather than sitting, especially when you will get him up to walk anyway”
Determined location of pain (paraspinal vs. spinal)	40 (88.89%)	5 (11.11%)	“Loved the explanations- ‘knobs' of the vertebrae, ‘guitar strings' of the paraspinals”	“Could try to get the patient to point or find specifically where the maximal point of tenderness is”
Assessed strength testing (toe/heel walk)	24 (53.33%)	21 (46.67%)	“<Student> recommended that the patient angle his camera downwards to see better”	“Had patient get out of the chair but did not do toe/heel walk”
Provided clarity of instruction in guiding the patient through the physical exam	42 (93.33%)	3 (6.67%)	“<Student> demonstrated the maneuvers herself and partnered with the patient”	“Might want to advise the patient to tilt the camera to see the maneuvers fully”

Comments from four faculty members on summary PDF sent to students at an academic medical center. Comments have been lightly edited for anonymity and grammar.