key: cord-1004640-kcy1lq4t authors: Haucke, Elisa; Walldorf, Jens; Ludwig, Christiane; Buhtz, Christian; Stoevesandt, Dietrich; Clever, Katharina title: Application of telepresence systems in teaching – transfer of an interprofessional teaching module on digital aided communication into the block training “internal medicine” during the Covid-19 pandemic date: 2020-12-03 journal: GMS J Med Educ DOI: 10.3205/zma001377 sha: 012c0f2570d984ca30bbb5201fe240716ac4cce8 doc_id: 1004640 cord_uid: kcy1lq4t Objective: The contact restrictions caused by the Covid-19 pandemic fundamentally limit patient-centered teaching. To realize a patient-oriented education in the block training “Internal Medicine” at the University Hospital Halle (Saale) despite the challenges, the already established teaching module “Interprofessional Teleconsultation” was adapted. The short article outlines the interprofessional teaching module including first evaluation results and describes the adapted block training. Method: In the “Internal Medicine” block training, students in a lecture hall navigated a telepresence system, which was accompanied by a physician across the ward and conducted an anamnesis via video and audio transmission without actual patient contact. Results: Students, physicians, and patients were open-minded about this form of communication during the Covid-19 pandemic and quickly got accustomed to the use of the telepresence system. To be able to react to technical challenges (e.g. unstable connection between the communication partners), a careful preparation of the lecturers is necessary. Conclusion: In using a telepresence system, patient-oriented teaching of students in the block training “Internal Medicine” can be ensured with low-threshold technical effort during the Covid-19 pandemic. The telepresence system allows for the involvement of patients into teaching while adhering to the necessary hygiene measures. Despite technical challenges, the teaching format based on telepresence is suitable as an alternative to face-to-face teaching if actual patient contact is not possible. Telemedicine provides an opportunity to make better use of medical knowledge not only spatially but also crosssectoral and to ensure comprehensive medical care [1] . During the Covid-19 pandemic, telemedical care has become increasingly important [2] . This article shows how telecommunication was used in the block training "Internal Medicine" during the Covid-19 pandemic (summer semester 2020) to ensure patient-oriented medical education at the University Hospital Halle (Saale; UKH) despite strict contact restrictions. For this purpose, the already established teaching module "Interprofessional Teleconsultation" [3] was adapted. In the following, the teaching module "Interprofessional Teleconsultation", including first evaluation results as well as the adapted block internship "Internal Medicine" are presented. The adaptation of a telepresence-based teaching module shows how practical teaching during the Covid-19 pandemic can be realized based on already existing teaching formats in a resource-saving manner. The teaching module "Interprofessional Teleconsultation" is embedded in an interprofessional teaching series (Project GReTL2.0 -Health Professions in Reflective and Transformative Learning) [4] . Medical and nursing students use a remote-controlled telepresence system (Double2, Double Robotics, USA) in patient conversations and reflect on its use. The mobile telepresence system offers the opportunity to communicate from a distance via video conferencing and to move around in a different environment. After a lecture on the subject of "Digitaliza- Figure 1 : Visit with telepresence system in the teaching module "Interprofessional Teleconsultation" Table 1 : Evaluation of the organisation of the teaching module "Interprofessional Teleconsultation" tion and Assistive Technology", a simulated visit with an acting patient in an inpatient care facility is prepared in interprofessional groups. The nurse is on site with an immobile resident, while the physician is connected via a telepresence system. The physician navigates the telepresence system via a laptop from a simulated family practice (see figure 1 ). In a structured feedback session, students reflect on the experienced visit and discuss the possibilities and limits of telepresence systems. The piloting of the teaching module was evaluated by 29 students (16 nursing, 13 medicine). The evaluation results indicate a high acceptance of the module procedure and the didactical structure (see table 1 ). The teaching module thus offers the opportunity of interprofessional sensitization for the use of digital technologies in the professional context. Contact restrictions due to the Covid-19 pandemic considerably limit patient-based teaching. However, "presence" plays an important role especially in the contact with patients. The teaching module "Interprofessional Teleconsultation" was therefore adapted for teaching in the block training "Internal Medicine". In comparison to the simulated patient conversation in the teaching module "Interprofessional Teleconsultation", the data protection officer and the head of information and communication technology at the UKH were involved in the clinical application in order to ensure a secure and stable data transfer. In each three-hour block training, 20 medical students participated in a lecture hall in compliance with the current hygiene regulations (distance, face masks, hand disinfection). The students accompanied a physician across the ward via video transmission, using a telepres-ence system and alternately conducted an anamnesis with different patients (approx. 3-4), using the digital medical record. One student was at the laptop and conducted the conversation with the patient, while the other students saw the patient on a screen. To support the conversation, the students also used individual visual, macroscopic aspects for the differential diagnosis. The anamnesis was accompanied and moderated, if necessary, by a second physician in the lecture hall. Patients were informed in advance about the setting. Oral consent was obtained and documented in the patient file. Overall, both students and physicians appreciated that patient contact was facilitated in the current pandemic situation and quickly got used to the use of the telepresence system. In our experience, patients were also openminded towards this form of communication. The challenge of using a telepresence system in the "Internal Medicine" block training lies primarily in ensuring a stable connection between the communication partners. Limitations can lead to a loss of quality in the transmission of images and sound. This in turn causes delays in the process and leads to misunderstandings in communication. To be able to meet possible technical challenges ad hoc, careful preparation of the lecturers and the involved department/ward is necessary. Despite strict contact restrictions during the Covid-19 pandemic, the use of a telepresence system enables students to actively participate in actual patient conversations while maintaining the necessary hygiene measures to protect the patients. In the future, the telepresence system may also be used in other situations, e.g., to enable students to participate in the rounds of infectious patients. In addition to internal medicine, telepresence-based block trainings are already being carried out at other wards of the UKH (e.g., paediatrics) or as outpatient trainings (e.g., orthopaedics, reproductive medicine, urology). Despite technical challenges, a teaching format that includes a telepresence system is suitable as an alternative to face-to-face teaching if actual patient contact is not possible. Die Autor*innen erklären, dass sie keinen Interessenkonflikt im Zusammenhang mit diesem Artikel haben. Telemedicine in Germany: Status, barriers, perspectives Digitale Kommunikation in der Medizin -interprofessionelles Telekonsil Gemeinsam besser werden für Patienten: Interprofessionelle Lehrkonzepte aus der Förderung der Robert Bosch Stiftung Telemedicine in Germany: Status, barriers, perspectives Digitale Kommunikation in der Medizin -interprofessionelles Telekonsil Gemeinsam besser werden für Patienten: Interprofessionelle Lehrkonzepte aus der Förderung der Robert Bosch Stiftung Application of telepresence systems in teaching -transfer of an interprofessional teaching module on digital aided communication into the block training "internal medicine" during the Covid-19 pandemic The authors declare that they have no competing interests.Abbildung 1: Visite mit Telepräsenzroboter im Lehrmodul "Interprofessionelles Telekonsil" Tabelle 1: Evaluation der Organisation des Lehrmoduls "Interprofessionelles Telekonsil" Lehrmodul "Interprofessionelles Telekonsil"Das Lehrmodul "Interprofessionelles Telekonsil" ist eingebettet in die curricular verankerte interprofessionelle Lehrreihe (Projekt GReTL2.0 -Gesundheitsberufe im reflexiven und transformativen Lernen) [4] . Studierende bzw. Auszubildende der Medizin und Pflege wenden ein ferngesteuertes Telepräsenzsystem (Double2, Double Robotics, USA) im Patientengespräch an und reflektieren dessen Einsatz. Das mobile Telepräsenzsystem bietet per Videokonferenz die Möglichkeit, aus der Distanz zu kommunizieren und sich in einer anderen Umgebung fortzubewegen. Nach einem Impulsvortrag zum Thema "Digitalisierung und assistive Technologie" wird in interprofessionellen Kleingruppen eine simulierte Visite mit einem*r Schauspielpatient*in in einer stationären Pflegeeinrichtung vorbereitet. Die Pflegefachperson befindet sich bei einem*r immobilen Bewohner*in vor Ort, während der*die Hausärzt*in über ein Telepräsenzsystem zugeschaltet ist. Der*die Hausärzt*in navigiert das Telepräsenzsystem über einen Laptop aus einer simulierten Hausarztpraxis (siehe Abbildung 1). Im abschließenden strukturierten Feedback werden die erlebte Visite reflektiert sowie Möglichkeiten und Grenzen von Telepräsenzsystemen diskutiert. Die Pilotierung des Lehrmoduls wurde von 29 Teilnehmenden (16 Pflegeauszubildende, 13 Medizinstudierende) evaluiert. Die Evaluationsergebnisse weisen auf eine hohe Akzeptanz des Modulablaufs und des didaktischen Aufbaus hin (siehe Tabelle 1). Das Lehrmodul bietet damit die Möglichkeit der berufsgruppenübergreifenden Sensibilisierung für den Einsatz digitaler Technologien im Berufsalltag. Da die Kontakteinschränkungen durch die Covid-19-Pandemie die patientennahe Lehre erheblich beeinträchtigen, "Präsenz" gerade im Patientenkontakt aber eine wichtige Rolle spielt, wurde das Lehrmodul "Interprofessionelles Telekonsil" für die Lehre im Blockpraktikum "Innere Medizin" adaptiert. Im Vergleich zum simulierten Patientengespräch im Lehrmodul "Interprofessionelles Telekonsil" musste im klinischen Einsatz der Datenschutzbeauftragte sowie der Leiter der Informations-und Kommunikationstechnik des UKH einbezogen werden, um eine sichere und stabile Datenübertragung zu gewährleisten. An dem dreistündigen Blockpraktikum nahmen jeweils 20 Medizinstudierende unter Einhaltung der geltenden Hygienevorschriften (Abstand, Mund-Nasen-Schutz, Händedesinfektion) in einem Hörsaal teil. Per Videoübertragung mittels Telepräsenzsystem begleiteten die Studierenden eine*n Ärzt*in über die Station und führten abwechselnd mit verschiedenen Patient*innen (ca. 3-4), unter Einbezug der digitalen Krankenakte, Anamnesegespräche. Dabei befand sich jeweils ein Studierender am Laptop und führte das Gespräch mit dem*r Patient*in, während die anderen Studierenden den*die Patient*in über eine Leinwand sahen. Zur Unterstützung der Gesprächsführung zogen die Studierenden ggf. auch einzelne visuelle, makroskopische Aspekte für die Differentialdiagnostik heran. Die Anamnesegespräche wurden von einem*einer zweiten Ärzt*in im Hörsaal begleitet und ggf. moderiert. Die Patient*innen wurden im Vorfeld über das Setting informiert sowie das mündliche Einverständnis eingeholt und in der Patientenakte dokumentiert. Insgesamt schätzten sowohl die Studierenden als auch die Ärzt*innen den ermöglichten Patientenkontakt in der aktuellen Pandemie-Situation und gewöhnten sich schnell