Analyze how online learning prepares students for remote care environments

The pandemic has changed the way care has been delivered, but what novice healthcare professionals know about the strategies used to connect with patients in a virtual setting, or the quality of instruction they receive , not known.

A recently published study aimed to examine the body of knowledge that currently exists – and identify gaps – used to prepare those entering health care, education or other “caring” professions in remote settings.

In face-to-face situations, “body language, emotional cues, and compassion can be more easily and naturally communicated and experienced,” the authors noted.

However, the pandemic has altered the skills new entrants to these professions need as they prepare to provide care virtually.

The review, conducted in February 2021, focused on undergraduate and/or graduate education and reviewed current strategies for delivering online learning as well as its implementation. The analysis also included “student and teacher perspectives, learning outcomes, students’ ability to develop professional skills and competencies, and patient or learner perspectives”.

The search of 8 databases excluded studies published more than 10 years ago.

The researchers used the Effective Public Health Practice Project (EPHPP) Quality Appraisal Tool to rate each quantitative study as strong, moderate, weak, or not applicable across 6 domains of validity and reliability.

Qualitative studies were assessed using the Joanna Briggs Institute’s Critical Appraisal Checklist for Qualitative Research, which assesses each in 10 domains. Mixed methods studies used both tools.

A total of 16,248 unique studies were identified, 609 underwent full-text secondary screening and 38 were ultimately included; 50% (n=19) of the studies were published in the last 3 years. Most (63%) are from the United States.

Most of the studies focused on medicine (n=14, 37%), education (n=12, 32%) and nursing (n=6, 16%).

Including mixed methods studies, 29 (76%) studies were quantitative methods and 28 (74%) were qualitative.

Quantitative studies were rated as weak due to their design (n=24, 83%), lack of blinding (n=29, 100%) and data collection methods (n=21, 72). %). Qualitative studies were also rated weak due to incongruous methods (n=6.21%), unclear interpretations of results (n=13.46%), and incongruous conclusions (n=8.28%).

Courses ranged from 2 hours to 18 weeks.

Teaching methods included videoconferencing, remote care demonstration, online modules, patient consultation, and other methods. More than half of the studies used more than one method and 9 used 3 or more methods.

Remote care demonstrations were the most common teaching method.

Audio/video conferencing and e-learning systems were the 2 most commonly used types of teaching technologies.

Learning assessments included performance-based assessments, discussions, critical reflections, development of online tools, and other assessments. Performance-based assessments, where students showed they could use the technology in real or simulated settings, were the most commonly used type.

Course learning objectives included developing digital skills and preparing for future online practice; these were the most common. Other goals included the development of discipline-specific remote care skills and the assessment of students or patients online.

“Students reported increased comfort and confidence when working with technology and planning and providing remote patient care,” the authors said.

However, the quality of the studies was variable.

“More emphasis needs to be placed on assessment, training and research to help students use digital technologies and develop the interpersonal and technological skills needed to work in remote environments, the authors concluded.


Nowell L, Dhingra S, Carless-Kane S, et al. A systematic review of online education initiatives to develop students’ remote care skills and practices. Med Educ online. Published online June 12, 2022. doi:10.1080/10872981.2022.2088049

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