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Analyzing How Online Learning Prepares Students for Remote Care Settings


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

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

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

However, the pandemic has changed the skillsets that are needed by new entrants into these professions as they prepare to deliver care virtually.

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

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

Researchers used the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) 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 Critical Appraisal Checklist for Qualitative Research, which rates each across 10 domains. Mixed methods studies used both tools.

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

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

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

Quantitative studies were judged to be weak due to their design (n = 24, 83%), absence of blinding (n = 29, 100%), and data collection methods (n = 21, 72%). Qualitative studies were also deemed to be weak due to incongruent methods (n = 6, 21%), unclear interpretations of results (n = 13, 46%), and incongruent conclusions (n = 8, 28%).

Courses ranged from 2 hours to 18 weeks.

Instructional methods included video conferencing, demonstration of remote care, online modules, consultation with patients, and other methods. More than half of the studies used more than 1 method and 9 used 3 or more methods.

Demonstrations of remote care was the most common instructional method.

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

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 technology in real or simulated settings, were the most common type used.

Learnings objectives for the courses included developing digital skills and preparing for future online practice; these were the most common. Other objectives included building discipline-specific remote caring skills, and assessing students or patients online.

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

However, study quality was variable.

“More emphasis on assessment, training, and research is required to support students in using digital technologies and developing interpersonal and technological skills required to work in remote settings,” the authors concluded.


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

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