Abstract
Background
There has been a steady increase in the adoption of telemedicine over time, with a dramatic surge in use during the COVID-19 pandemic. This rapid expansion highlighted telemedicine’s importance in healthcare delivery but created uncertainty for medical educators regarding how best to integrate clinical learners into virtual visits. To address this gap, we conducted a multi-institutional, cross-sectional survey using snowball sampling to evaluate telemedicine workflows used to incorporate clinical students into patient encounters during the pandemic.
Objective
To describe how clinical students and educators perceived student participation models, educator workflows, and platform features that supported learner integration into telemedicine encounters during the COVID-19 pandemic.
Methods
We conducted an observational cross-sectional survey of third and fourth-year allopathic and osteopathic medical students, second-year physician assistant (PA) students, and clinical educators (resident and attending physicians, and advanced practice providers) in the United States between November 2020 and February 2021. We distributed the questionnaire electronically to educators at eligible institutions and used a snowball sampling; a response rate could not be calculated given this recruitment method. Survey items addressed participant demographics, telemedicine platforms used, availability of telemedicine curricula, workflows for integrating remotely located students into live patient encounters, and perceived educational utility of telemedicine.
Results
In total, 95 students and 115 educators completed the survey. Among student respondents to the primary outcome item (n = 83), 75 students (90.4%) perceived telemedicine to be beneficial to their medical education. Of those who reported benefit, 57 students (76.0%) perceived that participation in telemedicine visits was helpful for future clinical practice. Both students and educators perceived several telemedicine platform features as supportive educational encounters, including the ability to add learners to patient encounters, the absence of time limits on visits, and functionality that allows post-encounter case debriefing between educators and learners. Many respondents reported that their telemedicine platforms lacked these features, which they perceived as limiting optimal educational integration.
Conclusion
Telemedicine represents a valuable and enduring modality for integrating clinical education into patient care workflows. Survey findings indicate that participants perceived telemedicine teaching workflows to be most effective when they mirrored traditional face-to-face clinical encounters. Though students perceived telemedicine participation as helpful preparation for future practice, inconsistent platform capabilities and lack of standardized workflows were identified as ongoing challenges. These findings are exploratory and reflect perceptions rather than objective outcomes. Developing standardized guidance and advocating for platforms that support multiple participants are essential to optimize learner integration and ensure high-quality clinical education in virtual care environments.
Keywords: telemedicine, health professions education, clinical training, workflow, telehealth integration
Introduction
The COVID-19 pandemic precipitated a major disruption to healthcare delivery services and undergraduate medical education in the United States. In many circumstances, medical schools suspended medical student participation in face-to-face clinical rotations and direct patient care activities.1-4 Healthcare organizations rapidly adopted telemedicine to provide outpatient care, creating an urgent need to redesign student clerkships. Educators needed to devise ways for clinical learners to participate meaningfully in patient encounters when physically separated from their supervising preceptors. Although many medical specialties offered telemedicine as an option before the pandemic, the sudden and widespread implementation exposed uncertainty among educators regarding how to integrate clinical students into live virtual visits in ways that preserve educational value.1,2,5
Telemedicine utilization increased markedly during the COVID-19 pandemic and then enthusiasm waned afterwards as in-person services resumed. Telemedicine continues to play a substantial role in healthcare delivery because of its potential to enhance access, convenience, and continuity of care.2,6-8 Recent studies suggest that telemedicine has stabilized in the post-pandemic period, with relative utilization rates plateauing overall but varying substantially by specialty.2,7,9,10 Adoption remains highest in mental health and neurology, whereas general pediatrics and procedural subspecialties demonstrate comparatively low utilization.7,9 Notably, several specialties, particularly mental health, had incorporated telemedicine into routine practice prior to the pandemic, which may explain the sustained and comparatively higher use observed in these fields.2,9
For telemedicine to be sustainably integrated into routine practice, clinicians must feel comfortable using the technology and confident in its clinical effectiveness. Clinician comfort with telemedicine platforms is a key determinant of successful adoption.10,11 By contrast, clinicians expressing discomfort with telemedicine technology and workflows are significantly less likely to offer video-based care as an option.2,10 This underscores the importance of introducing telemedicine competencies during clinical training, when learners are actively developing professional habits and clinical workflows. Early exposure during clinical education may facilitate long-term adoption and effective use in independent practice.
Recognizing this need, the Association of American Medical Colleges (AAMC) published Telehealth Competencies Across the Learning Continuum in 2021, emphasizing that telemedicine skills are essential for contemporary clinical practice. 12 As a result, telemedicine curricula have been increasingly incorporated into undergraduate medical education, including during clinical clerkships. Prior reports indicate that many medical schools had already begun implementing telemedicine training during the pandemic, with a substantial proportion focused on clinical learners.3,11,13,14 As telemedicine becomes a routine component of patient care, clinical medical and physician assistant students must be adequately prepared to participate in virtual encounters in ways that support both patient care and educational objectives. 15 A national survey of French medical students and residents demonstrated that, despite widespread recognition of telemedicine’s potential to improve access to care, fewer than 15% had received formal training in telemedicine and nearly all felt insufficiently prepared to practice telemedicine. In the US pre-pandemic, only a minority of medical students (15-20%) reported exposure to telemedicine. 16 While the AAMC indicates nearly 90% of allopathic medical schools now offer telemedicine training, it is difficult to identify specific school-level data about the types of instructional interventions or proportions of students trained. 17 Lack of standardized, structured medical education has created practical implementation challenges for medical educators, highlighting a critical gap in the preparation of students and trainees for its effective use in clinical practice11,18
Despite growing consensus on the importance of telemedicine training, there remains limited empirical guidance on how to logistically integrate remotely located clinical students into live telemedicine encounters. While competency frameworks outline what learners should know and be able to do in virtual care settings,19-21 fewer studies have examined how traditional clinical teaching workflows, such as independent student interviews, case presentations, joint patient encounters, and post-visit teaching can be adapted to telemedicine environments.22,23 This lack of operational clarity poses challenges for clinician educators seeking to maintain educational quality while navigating platform limitations, time constraints, and evolving care models.
We hypothesize that telemedicine encounters are most educational for clinical students when they closely parallel in-person clinical workflows. Effective integration may include opportunities for students to independently interview patients, present cases to supervising clinicians, participate in joint virtual visits, and engage in post-encounter debriefing and teaching. To explore how these workflows were implemented during the COVID-19 pandemic, we conducted a multi-institutional cross-sectional survey of clinical medical and physician assistant (PA) students and their educators. 24
This study descriptively examined (1) how clinical students participated in telemedicine visits while physically separated from their supervising preceptors; (2) how clinician educators adapted their clinical workflow to incorporate learners into virtual patient encounters; (3) how medical students preferred to participate in telemedicine encounters; and (4) how telemedicine platform features were perceived to support learner integration. By incorporating perspectives from both students and educators, this study offers exploratory, perception-based insights to guide future development of clinical education in telemedicine settings.
Methods
Study Design
We conducted a cross-sectional, descriptive survey of third- and fourth-year allopathic and osteopathic medical students, second-year PA students, and clinical educators (attending and resident physicians, fellows, and advanced practice providers) in the US, between November 2020 and February 2021. The study assessed telemedicine platforms used within the prior 6 months. We also measured students’ and educators’ perceptions of platform ease of use and its effectiveness in supporting medical education. Participants were offered the opportunity to enter a gift card drawing upon completion of the survey while still maintaining the anonymity of their survey responses.
Participants & Recruitment
Recruitment occurred via email and social media using a single survey link. Targeted distribution included professional society listservs, medical school class lists, and student interest groups, many affiliated with obstetrics and gynecology. Snowball sampling invited recipients to forward the link to colleagues who met eligibility criteria. Because snowball sampling was used, the total number of individuals who received the survey link was unknown; therefore, a response rate could not be calculated. Upon link access, potential participants viewed an information sheet; participation was voluntary. Respondents could enter a drawing for four $50 gift cards via a separate survey that remained unlinked to primary responses. Upon completion of the primary survey, those interested in the incentive were directed to a secondary survey to provide their email address for contact. This separation ensured that the primary survey remained confidential, as the two surveys were not linked. All participants were informed that survey participation was entirely voluntary and could be withdrawn at any time. Email addresses collected via the secondary survey remained unlinked from primary survey responses.
Inclusion/Exclusion Criteria
Eligible students were third- or fourth-year medical students (MD/DO) or second-year PA students enrolled at US–based programs during the study period. Eligible educators were attending physicians, fellows, resident physicians, or advanced practice providers who taught medical or PA students in the US clinical settings. Pre-clinical students and individuals outside the US were not eligible. Participants could exit the survey at any time. No participants were excluded after survey initiation; analyses were conducted at the item level, including all available responses.
Survey Development
We did not identify any published or validated questionnaires exploring how educators incorporate students into clinical visits, including telemedicine encounters. Therefore, we designed a novel survey to answer our research questions. Before distributing the questionnaire, we piloted the instrument with 8 medical students and clinical educators to assess face validity; however, the survey did not undergo formal reliability or construct validity testing. This is acknowledged as a limitation of the study instrument. The pilot group represented the types of respondents expected in the full study, capturing both learners’ and educators’ perspectives. Feedback from the pilot was incorporated to refine question wording and ensure clarity, especially for questions on telemedicine workflows and platform interactions. The final survey assessed four domains: (1) telemedicine platforms used; (2) availability of platform features relevant to clinical education; (3) workflows for learner integration into telemedicine encounters; and (4) perceived educational value of telemedicine participation.
Data Collection
The data were collected via confidential electronic surveys using REDCap electronic data capture tools. The survey consisted of the following components: participant characteristics, telemedicine platform, student integration, and perceptions of medical education. Data were captured in REDCap and included: demographics (age, gender, race/ethnicity, multi-select, region, level of training), pre-pandemic telemedicine use (educators only), telemedicine use in the prior 6 months, predominant clinical setting (inpatient/outpatient/other), platform(s) used and features (e.g., ability to add third party, control of patient entry/exit, pre/post-visit educator–student communication, time limits), workflow preferences for precepting and debriefing, perceived educational value (Likert-type items), and perceived patient receptiveness to student involvement (educators).
Statistical Analysis
Response counts varied across survey items due to incomplete responses, and the number of valid responses for each item is reported in the corresponding tables. Descriptive statistics including means and standard deviations for continuous variables and frequencies and percentages for categorical variables were examined using IBM SPSS Statistics (Version 27). Because the study’s aims were to explore perceptions of telemedicine education, inferential statistics were not planned or conducted. Analyses were conducted at the item level; partially completed surveys were included for all questions that participants answered. Missing data were not included in the descriptive statistics.
Ethical Considerations
This study was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (IRB# 12574). Participation was voluntary and informed consent was obtained prior to survey initiation. This study adheres to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional research; the completed checklist is included in the supplemental materials.
Results
A total of 95 students and 115 educators completed the survey. Demographic characteristics of respondents are summarized in Table 1. Pre-pandemic telemedicine use was not assessed for students due to presumed limited exposure prior to clinical training. Student perceptions of telemedicine are presented first, followed by educator experiences and reported workflow preferences.
Table 1.
Demographic Characteristics of Student and Educator Respondents
| Variable | Students (n =95) | Educators (n = 115) |
|---|---|---|
| Age, mean (SD) | 26.2 (2.9) | 38.3 (9.2) |
| Gender | ||
| Male | 33 (34.7%) | 30 (26.1%) |
| Female | 62 (65.3%) | 85 (73.9%) |
| Race/Ethnicity 1 | ||
| American Indian or Alaska Native | 3 (3.2%) | 1 (0.9%) |
| Asian | 20 (21.1%) | 21 (18.3%) |
| Black or African American | 5 (5.3%) | 3 (2.6%) |
| Hispanic | 12 (12.6%) | 8 (7.0%) |
| Native Hawaiian or Pacific Islander | 0 (0.0%) | 0 (0.0%) |
| White or Caucasian | 68 (71.6%) | 85 (73.9%) |
| Level of Training | ||
| 3rd-year MD/DO student | 35 (36.9%) | — |
| 4th-year MD/DO student | 44 (46.3%) | — |
| 2nd-year PA student | 15 (15.8%) | — |
| 3rd-year PA student | 1 (1.1%) | — |
| Attending physician | — | 63 (54.8%) |
| Fellow physician | — | 9 (7.8%) |
| Resident physician | — | 36 (31.3%) |
| Other clinical educator | — | 7 (6.1%) |
| Region | ||
| Midwest | 6 (6.3%) | 19 (16.5%) |
| Northeast | 4 (4.2%) | 11 (9.6%) |
| South | 82 (86.3%) | 78 (67.8%) |
| West | 3 (3.2%) | 7 (6.1%) |
| Intended or Current Specialty | ||
| Family medicine | 13 (13.7%) | 11 (9.6%) |
| Internal medicine | 6 (6.3%) | 22 (19.1%) |
| Pediatrics | 16 (16.8%) | 10 (8.7%) |
| Medicine–pediatrics | 9 (9.5%) | — |
| Psychiatry | 7 (7.4%) | 14 (12.2%) |
| Obstetrics and gynecology | 6 (6.3%) | 40 (34.8%) |
| Surgery | 8 (8.4%) | 6 (5.2%) |
| Other | 21 (22.1%) | 12 (10.4%) |
| Undecided | 9 (9.5%) | — |
| Used telemedicine prior to the COVID-19 pandemic 2 | n/a | 10 (8.7%) |
| Used telemedicine in the past 6 months | 83 (88.3%) | 100 (87.0%) |
| Primary clinical setting for telemedicine | ||
| Inpatient | 9 (10.3%) | 5 (5.0%) |
| Outpatient | 77 (88.5%) | 95 (94.1%) |
| Other | 1 (1.1%) | 1 (0.9%) |
1Respondents had the option to select more than one race/ethnicity.
2N/A indicates that the item was not assessed for that participant group.
Student Perception of Telemedicine
Students were asked about their perception of telemedicine’s benefit to clinical medical education. These results are described in Table 2. For all related questionnaire items, student respondents indicated that they expected to use telemedicine in future practice and valued the inclusion of telemedicine exposure during their training.
Table 2.
Student Perceptions of Telemedicine
| Survey item | Strongly disagree | Disagree | Agree | Strongly agree |
|---|---|---|---|---|
| I will utilize telemedicine in the future in my chosen field/specialty of medicine. | 0 (0.0%) | 6 (6.3%) | 59 (62.1%) | 30 (31.6%) |
| The more often I use telemedicine, the more educational I find it. | 1 (1.2%) | 21 (25.6%) | 48 (58.6%) | 12 (14.6%) |
| Participating in telemedicine is beneficial to my medical education. | 2 (2.4%) | 6 (7.2%) | 54 (65.1%) | 21 (25.3%) |
Of the 95 student respondents, 83 answered the item assessing whether telemedicine was beneficial to their medical education; among these, 75 agreed or strongly agreed. Of these 75 students, 57 students (76.0%) perceived that participation in telemedicine encounters helped prepare them for telehealth use during residency or future practice. Additional perceived benefits included maintaining patient interaction during the COVID-19 pandemic 51 students (68.0%), enhancement of clinical knowledge 15 students (20.0%), and improvement in case presentation skills 14 students (18.7%).
Among the 8 students who did not agree that telemedicine improved their education, 2 (25.0%) reported lack of interest in future telemedicine use, 5 (62.5%) felt telemedicine was not the best use of their time, and 4 (50.0%) reported not receiving constructive feedback during telemedicine encounters.
Educator Experiences With Telemedicine
We explored educators’ perceptions of telemedicine and their experiences incorporating telemedicine into their practice and teaching. Questionnaire item language assumed students and educators were in different locations during a telemedicine encounter with a patient, since social distancing policies were largely enforced by training programs during the pandemic. Educators were asked how receptive patients were to a student involved in their telemedicine visit. Among the 48 educators who responded to this item, patients were reported to be always receptive in 28 cases (58.3%), often receptive in 14 cases (29.2%), sometimes receptive in 4 cases (8.3%), and rarely receptive in 2 cases (4.2%).
We asked educators and students about their preferred online learning strategies when communicating with each other. Participants reported a range of communication and workflow preferences (Table 3).
Table 3.
Platform Features and Workflow Preferences
| Workflow timing* | Students (n = 81) | Educators (n = 40) |
|---|---|---|
| Prior to start of telemedicine clinic session (e.g., beginning of the afternoon clinic) | 21 (22.1%) | 9 (7.8%) |
| Prior to start of a telemedicine visit for each individual patient | 22 (23.2%) | 19 (16.5%) |
| At start of each telemedicine visit, in front of patient | 3 (3.2%) | 5 (4.3%) |
| At conclusion of each telemedicine visit, in front of patient | 19 (20.0%) | 10 (8.7%) |
| Following conclusion of each telemedicine visit (after patient has logged off) | 45 (47.4%) | 22 (19.1%) |
| Following conclusion of telemedicine clinic session (e.g., end of morning clinic) | 17 (17.9%) | 14 (12.2%) |
| Other | 2 (1.0%) | 0 (0.0%) |
*Participants could select more than one response. Denominators vary by item due to item-level analysis of incomplete surveys.
We asked educators to indicate their level of agreement with the statement that they could effectively teach students about patients’ medical conditions via telemedicine. Out of the 45 respondents, none strongly disagreed, 7 (15.6%) disagreed, 27 (60.0%) agreed, and 11 (24.4%) strongly agreed. When asked about barriers affecting educational effectiveness, 1 (14.3%) of respondents cited time constraints imposed by competing clinical duties, 5 (71.4%) cited technological barriers associated with the digital platform, and 1 (14.3%) cited the additional time required to initiate an additional phone/video call with the student.
In response to educators being asked if they felt that students should receive training in telemedicine, 18 (42.9%) strongly agreed, 22 (52.4%) agreed, 1 (2.4%) disagreed, and 1 (2.4%) strongly disagreed. We asked educators if including students in video visits improved teaching effectiveness. 9 (20.9%) strongly agreed, 31 (72.1%) agreed, 7 (7.0%) disagreed, and 0 strongly disagreed.
Platform Preferences
One hundred fifteen educators identified strengths associated with their telemedicine platforms. 32 (27.8%) said it was easy for students to use the platform, and 42 (36.5%) said it was easy to invite a third party, such as a student, to join the visit. 20 (17.4%) of respondents stated they could communicate with the student on the platform before the patient joined the encounter, 23 (20.0%) stated they could speak with the student on the platform after the patient left the encounter, and 23 (20.0%) stated they had control over when the patient joined and left the encounter. Furthermore, 25 (21.7%) expressed there was no time limitation by the platform on the encounter with the patient. Figure 1 shows the preferred telemedicine platforms for educational purposes. The supplemental materials describe which platforms educators or students had used in the past six months
Figure 1.
Preferred telemedicine platforms for learner integration during clinical encounters
*Respondents could select more than one platform; percentages do not sum to 100%
Discussion
Principal Findings
Our survey results provide insight into how educators engaged medical and PA students in telemedicine encounters and how learners and educators perceived the educational value of these experiences. Although most students (88.3%) reported participating in telemedicine visits, few participated in a formal telemedicine curriculum at their institution. 25 This likely reflects the rapid implementation timeline for telehealth-based education imposed during the pandemic. Virtual preceptorships and other ad hoc training strategies at most institutions are likely developed before the establishment of structured curricular frameworks. While the AAMC has promoted competency-based telemedicine education, questions remain regarding how to operationalize and evaluate these competencies in clinical settings.
A key finding of this study is that both learners and educators expressed a strong preference for telemedicine workflows that mirror traditional in-person preceptorships. Respondents favored models that allow students to independently interview patients, present cases to supervising clinicians, participate in joint encounters, and engage in post-visit discussion and teaching. These preferences suggest that participants perceived greater educational value when virtual workflows more closely resembled traditional instructional models.
Educational Implications and Enduring Lessons
Although this survey was administered during the pandemic, our findings highlight educational considerations that remain relevant for post-pandemic times. Telemedicine is likely to be an important part of future healthcare service delivery models, and learners will likely encounter virtual care across a growing range of clinical specialties. Early exposure during clinical training may shape learners’ perceptions of telemedicine’s relevance and feasibility, though additional research is needed to confirm this relationship. Students who perceive telemedicine as educationally valuable and clinically relevant may be more likely to adopt it in future practice. Conversely, limited exposure or poorly designed curricula could contribute to disengagement or skepticism of telemedicine. These are preliminary observations based on self-reported perceptions and should be interpreted accordingly.
Our findings suggest that effective telemedicine education does not require fundamentally new teaching paradigms but rather thoughtful adaptation of existing clinical workflows. Emphasizing continuity between in-person and virtual encounters may help normalize telemedicine as a legitimate clinical modality rather than a temporary or inferior substitute.
Platform Characteristics and Workflow Support
Although educators may not be able to choose the telehealth solution for their organization, we believe they can help guide successful implementations by articulating the relative strengths and weaknesses of each platform within an educational context. This study highlights specific functional characteristics that support effective integration of learners. Respondents preferred platform features that adaptively engage multiple participants, support private instructional discussions before or after patient encounters, allow for student-led interviews, and permit customization of encounter duration. These features enable educators to replicate core elements of in-person clinical teaching, including case presentation, observation, and feedback.
While platform capabilities continue to evolve, many of the educational requirements we identified in this study are durable. Greater comfort with telemedicine during clinical training may influence these functional attributes as perceived priorities when selecting or configuring telemedicine platforms for educational use; future research is needed to evaluate their impact on measurable educational outcomes. Evaluating the platform based on educational functionality may help avoid misalignment between clinical operations and teaching needs.
Learner and Educator Perspectives
Student respondents commonly reported perceived educational benefits from telemedicine participation. Educators and student respondents described different perceived challenges and benefits related to telemedicine-based education (Table 3), which may reflect competing clinical demands, time pressures, and cognitive load associated with adopting new care modalities. Many educators in this sample were relatively new to telemedicine themselves, which may have limited their capacity to simultaneously manage patient care and teaching.
The higher proportion of students reporting perceived educational benefit, compared to educators, may reflect differences in perspective due to increased autonomy, exposure to novel care models, or improved access to educational opportunities during a period of widespread disruption. The difference in user perspectives underscores the need for institutionally supported educators’ development activities that ensure educators are equipped to teach effectively in virtual environments.
Comparison to Literature
The findings of Yaghobian et al. are consistent with our survey results, indicating that broadly positive attitudes toward telemedicine often coexist with limited training and variable implementation practices. 26 Specifically, their national study of French medical schools identified clear gaps in structured telemedicine education despite widespread institutional support, a pattern that closely reflects the barriers reported by our respondents. Taken together, these findings suggest that lack of training and standardization continue to hinder the effective integration of telemedicine into routine practice. 26
Prior to the pandemic, very few medical schools or graduate-level training programs offered formal telemedicine clerkships.18,20 Some medical schools used the opportunity to trial new curricula with tailored educational program objectives aligning with AAMC telehealth competencies.5,27 In March 2021, the AAMC published Telehealth Competencies Across the Learning Continuum to establish telemedicine curriculum guidelines in undergraduate education. 25 These prior literatures have proposed frameworks and practice guidance for integrating learners into telemedicine encounters, including recommendations for pre-visit preparation, role clarification, and structured feedback.4,28-31 This study complements existing conceptual models by providing descriptive, dual-perspective data from learners and educators across multiple sites. Findings are exploratory and may inform hypothesis generation and pragmatic considerations for future implementation work.
Limitations
This study has several limitations. As a descriptive survey, it cannot establish causal relationships or assess the effectiveness of specific telemedicine workflows on objective educational outcomes. The survey instrument piloted for face validity only; formal reliability and construct validity testing were not conducted, which limits the interpretability of the measures. Responses reflect perceptions during a unique period of healthcare disruption and may not fully generalize to post-pandemic practice.
This study employed a snowball sampling approach, introducing potential selection bias due to recruitment through the investigators’ professional networks. Because responses were self-reported, they are subject to response bias and social desirability effects.
Additionally, platform capabilities may have evolved since data collection. Zoom was the most preferred telemedicine platform among students and educators but this can be confounded by the popularity of the platform outside of the clinical setting, when also being utilized for lectures and meetings. This likely contributed to familiarity and comfort with this platform compared to other available platforms for telemedicine encounters. As a result, many ranked this platform highest as their most preferred. Nonetheless, the consistency of preferences across respondents suggests that the identified platform capabilities are relevant to future telemedicine integration.
This study includes a small sample size (n=210). Due to the snowball sampling approach, it was not possible to collect data from a larger, specific number of people. Due to the sample size, it was not possible to conduct inferential comparisons between students and educators. Future studies with larger samples could explore differences between students and educators in more depth. We observed missing data from participants who did not complete the entire survey, which may have reduced the sample size for certain analyses and could affect the robustness of the conclusions. Analyses were conducted at the item level, and incomplete surveys were retained for items that were answered. As a result, denominators varied across survey questions. This approach maximized use of available data but may introduce response bias if participants who skipped items differed systematically from those who completed all questions. Because responses reflect self-reported perceptions rather than objective outcomes, missing data may disproportionately affect estimates of less common experiences or preferences. However, patterns of responses were generally consistent across related items, suggesting that missing data are unlikely to substantially alter the overall descriptive conclusions
Participants are largely located in the southern U.S. This is attributable to the nature of the survey distribution, as the investigators are affiliated with an academic institution located in the southern US, and most professional contacts were also from this region. There was also a higher concentration of educator respondents in the field of obstetrics and gynecology, reflecting the specialty and professional contacts of the principal investigator. The following observations reflect findings from prior national literature and are not direct results from our study sample. Notably, telemedicine utilization is the lowest among obstetricians and gynecologists and other surgical specialties, while psychiatry and primary care demonstrate the greatest use of telemedicine.9,10 This contrast underscores the importance of understanding barriers to telemedicine adoption and the factors influencing why certain providers integrate it less frequently into practice. The regional and specialty concentration of respondents limits the generalizability of findings to other geographic regions and clinical contexts.
Recommendations
Understanding barriers to telemedicine use within medical education and clinical clerkship curricula is an important first step in enhancing telemedicine exposure for future clinicians. Greater comfort with telemedicine during clinical training may influence learners’ perceptions of telemedicine and their willingness to engage with this modality in future practice; however, this relationship is preliminary and requires further evaluation with objective outcomes. This survey identified platform functionality as a key factor perceived by both learners and educators in supporting integration. Respondents highlighted the importance of platforms that allow interaction between students and preceptors before and after patient encounters, as much teaching occurs in these moments. Platforms that permit students to independently interview patients without the educator present were valued for providing learners opportunities to practice clinical skills and develop autonomy. Incorporating these perceived needs into clinical curriculum design may help optimize learner engagement in telemedicine-based education.
Conclusion
At the time of this study, the COVID-19 pandemic rapidly accelerated the adoption of telemedicine, creating new challenges and opportunities for clinical educators. Survey participants indicated several perceived needs and preferences for integrating students into telemedicine visits, including platform features that support independent student participation, controlled patient flow, and structured post-encounter debriefing, as well as workflows that reflect traditional in-person clinical teaching.
These findings reflect perceptions and preferences rather than measured effectiveness and provide insight into how clinical educators and institutions might pragmatically design telemedicine experiences for learners. By prioritizing platform capabilities and workflows that align with learner and educator preferences, medical education programs can better support student engagement and perceived educational value in virtual care environments.
Supplemental Material
Supplemental material for Integrating Medical and Physician Assistant Students Into Telemedicine: A Survey of Clinical Workflow and Platform Capabilities Among Clinical Students and Educators by Monica Henning, Sarah Beth Bell, Danielle Lewis, Blake Lesselroth, MD, Allyson Rowe, MD, Krista M. Kezbers, Guimy R. Castor, Jameca R. Price in Journal of Medical Education and Curricular Development
Supplemental material for Integrating Medical and Physician Assistant Students Into Telemedicine: A Survey of Clinical Workflow and Platform Capabilities Among Clinical Students and Educators by Monica Henning, Sarah Beth Bell, Danielle Lewis, Blake Lesselroth, MD, Allyson Rowe, MD, Krista M. Kezbers, Guimy R. Castor, Jameca R. Price in Journal of Medical Education and Curricular Development
Supplemental material for Integrating Medical and Physician Assistant Students Into Telemedicine: A Survey of Clinical Workflow and Platform Capabilities Among Clinical Students and Educators by Monica Henning, Sarah Beth Bell, Danielle Lewis, Blake Lesselroth, MD, Allyson Rowe, MD, Krista M. Kezbers, Guimy R. Castor, Jameca R. Price in Journal of Medical Education and Curricular Development
Acknowledgement
We would like to thank the Office for Research Development and Scholarly Activity (ORDSA) for contributing financial support, Nick Hollman for his help in analyzing the results and writing the results section, Kylie Hendricks, MA for gathering references and proofreading the manuscript, and Carol Cox, PhD for helping with IRB submission.
Appendix.
Abbreviations List
- AAMC
Association of American Medical Colleges
- APP
Advanced Practice Provider
- COVID-19
Coronavirus Disease 2019
- DO
Doctor of Osteopathic Medicine
- IBM SPSS
International Business Machines Statistical Package for the Social Sciences
- IRB
Institutional Review Board
- MD
Doctor of Medicine
- PA
Physician Assistant
- SD
Standard Deviation
- STROBE
Strengthening the Reporting of Observational Studies in Epidemiology
- US
United States
- n/a
Not assessed/Not applicable
- REDCap
Research Electronic Data Capture.
Author Contributions: The authors confirm contribution to the paper as follows: study conception and design: Monica Henning, MD, Sarah Beth Bell, PhD, Danielle Lewis, MD, Jameca Price, MD, Krista Kezbers, PhD. Author, data collection: Monica Henning, MD, Danielle Lewis, MD, Author; analysis and interpretation of results: Monica Henning, MD, Sarah Beth Bell, PhD Author; draft manuscript preparation: Monica Henning, MD, Sarah Beth Bell, PhD, Blake Lesselroth, MD, Allyson Rowe, MD, Jameca Price, MD, Krista Kezbers, PhD, Guimy R Castor, MPH. All authors reviewed the results and approved the final version of the manuscript.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material: Supplemental material for this article is available online.
ORCID iDs
Blake Lesselroth https://orcid.org/0000-0001-6170-7964
Krista M. Kezbers https://orcid.org/0009-0008-5485-1704
Guimy R. Castor https://orcid.org/0000-0002-0744-3096
Ethical Considerations
This study was approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center (IRB# 12574).
Consent to Participate
Participation in the survey was voluntary, and informed consent was implied prior to its initiation.
Data Availability Statement
Survey data available upon request.*
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplemental material for Integrating Medical and Physician Assistant Students Into Telemedicine: A Survey of Clinical Workflow and Platform Capabilities Among Clinical Students and Educators by Monica Henning, Sarah Beth Bell, Danielle Lewis, Blake Lesselroth, MD, Allyson Rowe, MD, Krista M. Kezbers, Guimy R. Castor, Jameca R. Price in Journal of Medical Education and Curricular Development
Supplemental material for Integrating Medical and Physician Assistant Students Into Telemedicine: A Survey of Clinical Workflow and Platform Capabilities Among Clinical Students and Educators by Monica Henning, Sarah Beth Bell, Danielle Lewis, Blake Lesselroth, MD, Allyson Rowe, MD, Krista M. Kezbers, Guimy R. Castor, Jameca R. Price in Journal of Medical Education and Curricular Development
Supplemental material for Integrating Medical and Physician Assistant Students Into Telemedicine: A Survey of Clinical Workflow and Platform Capabilities Among Clinical Students and Educators by Monica Henning, Sarah Beth Bell, Danielle Lewis, Blake Lesselroth, MD, Allyson Rowe, MD, Krista M. Kezbers, Guimy R. Castor, Jameca R. Price in Journal of Medical Education and Curricular Development
Data Availability Statement
Survey data available upon request.*