Tele-oncology in the COVID-19 Era: Are Medical Students Left Behind?
Authors: Kathrine S. Rallis, Andrea M. Allen-Tejerina
Journal: Trends in cancer (2020)

We read, with interest, the recent article by Shirke et al. [1.Shirke M.M. et al.Tele-oncology in the COVID-19 era: the way forward?.Trends Cancer. 2020; 6: 547-549Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar] 'Tele-oncology in the COVID-19 Era: The Way Forward?', describing the benefits and limitations of tele-oncology and its role during the coronavirus disease 2019 (COVID-19) pandemic. As medical students experiencing the disruptions caused by COVID-19, this article resonates with us. We appreciate the value of telemedicine in cancer services and agree that tele-oncology offers excellent prospects to help patients with cancer during COVID-19 and in the future. Yet, we are confronted with the fact that there is little mentioned by the authors of the opportunities and challenges associated with integrating telemedicine education and training (ET) in tele-oncology. In response to this statement, here, we set out ways in which telemedicine ET can be integrated in tele-oncology services for medical students. In addition, we discuss challenges of telemedicine ET and propose ways to overcome these. Emergence of the COVID-19 pandemic has exerted an unprecedented strain on medical education. As medical students interested in specialising in oncology, we are disheartened by the missed learning opportunities caused by the suspension of clinical placements and cancellation of summer electives and research programmes. Although there has been an accelerated transition to telemedicine ET through virtual conferences, webinars, online platforms, and free open-access medical education (FOAMed), these predominantly offer theoretical education, with little hospital training and medical simulation [2.Yaghobian S. et al.Knowledge, attitudes and practices of telemedicine education and training of French medical students and residents.J. Telemed. Telecare. 2020; (Published online June 9, 2020. https://doi.org/10.1177/1357633X20926829): 1-9Google Scholar]. We are concerned that reductions in clinical teaching will hinder our clinical skills performance and self-confidence. Even though all aspects of medical education have been significantly disrupted, we believe that oncology is disproportionately affected because it is already underrepresented [3.Payne S. et al.Discordance between cancer prevalence and training: a need for an increase in oncology education.Clin. Med. (Lond.). 2013; 13: 50-56Crossref PubMed Scopus (23) Google Scholar, 4.Cave J. et al.Medical student teaching in the UK: how well are newly qualified doctors prepared for their role caring for patients with cancer in hospital?.Br. J. Cancer. 2007; 97: 472-478Crossref PubMed Scopus (55) Google Scholar, 5.Mattes M.D. et al.A nationwide medical student assessment of oncology education.J. Cancer Educ. 2016; 31: 679-686Crossref PubMed Scopus (49) Google Scholar]. Furthermore, early specialty exposure through academic opportunities and mentorships significantly increases the likelihood of medical students pursuing oncology-related careers [6.Haupt T.S. et al.Medical student exposure to radiation oncology through the Pre-clerkship Residency Exploration Program (PREP): effect on career interest and understanding of radiation oncology.J. Cancer Educ. 2020; 35: 388-394Crossref PubMed Scopus (8) Google Scholar, 7.Branstetter B.F. et al.Preclinical medical student training in radiology: the effect of early exposure.Am. J. Roentgenol. 2007; 188: W9-W14Crossref PubMed Scopus (162) Google Scholar, 8.Pianosi K. et al.Medical student career choice: a qualitative study of fourth-year medical students at Memorial University, Newfoundland.CMAJ Open. 2016; 4: E147-E152Crossref PubMed Google Scholar]. The decline in such experiences amid COVID-19 may impede oncology specialty selection, causing a shortage of trainees to join a workforce that is already overstretched [9.Royal College of Radiologists Clinical Oncology UK Workforce Census 2017. Royal College of Radiologists, 2017Google Scholar,10.Erikson C. et al.Future supply and demand for oncologists : challenges to assuring access to oncology services.J. Oncol. Pract. 2007; 3: 79-86Crossref PubMed Scopus (402) Google Scholar]. Increased physician burnout and poorer quality oncology services will likely result. To prevent these outcomes, we believe a revitalised medical education effort is crucial. If telemedicine is indeed the way forward, it is paramount to incorporate medical student ET. First, streaming tele-oncology clinics is an easy method to offer clinical exposure to medical students who are restricted from attending clinical placements. Live participation in outpatient clinics through videocall and webchat offers real-time patient access, replacing the need for students, doctors, and patients to be in physical proximity and, thus, risking COVID-19 contraction. Allowing students to interview and clerk patients online can offer invaluable clinical experience. Students can assist in taking notes during consultations, supporting clinicians' undivided attention to patients. Additionally, medical students should be invited to join virtual multidisciplinary team (MDT) meetings, which are easily accessible and a treasured source of learning. Most importantly, we strongly advocate for the provision of remote access to electronic patient records (EPR) for all clinical year students. We believe that such access will cause a paradigm shift, enabling students to familiarise themselves with patient cases and bolstering student research initiatives by allowing them to conduct audits, retrospective patient studies, and case-series remotely. Indeed, restricted access to EPRs is a main obstacle in students' preparation for clinical practice [11.Welcher C.M. et al.Barriers to medical students' electronic health record access can impede their preparedness for practice.Acad. Med. 2018; 9: 48-53Crossref Scopus (40) Google Scholar]. Telemedicine ET has its limitations, including the fact that medical students cannot practice physical examinations. Moreover, face-to-face patient exposure offers a better chance of cultivating empathy, practicing motivational interviewing, observing body language, and engaging in more sensitive patient discussions. Additionally, the presence of medical students in virtual clinics may reinforce uncomfortable feelings from patients who already report increased nervousness, emotional distance and difficulty, or reluctance, associated with communicating with providers using television-based systems [12.Kitamura C. et al.How effective is video consultation in clinical oncology? A systematic review.Curr. Oncol. 2010; 17: 17-27Crossref PubMed Scopus (89) Google Scholar]. Lastly, although remote access to EPRs will exponentially increase research output and aid clinical learning, it also poses a risk to patient confidentiality by information miss-sharing. Undergraduate medical curricula must be revised to prepare future doctors for a telemedicine-dominant era. Training students on tele-oncology tools and increasing awareness of their limitations should form part of undergraduate education. Medical schools must teach students how to decide when telemedicine is appropriate by triaging patients who require in-clinic assessment. Emphasis should be placed on developing online communication skills and reassuring patients who are reluctant to use television-based systems. Lastly, students must recognise that tele-oncology needs require modification on a case-by-case basis. Given that the duration of healthcare disruptions remains unknown, with a significant backlog in services anticipated even after the pandemic has subsided, medical ET cannot be neglected. The pandemic has accelerated the transition to tele-oncology, unmasking a new era in telemedicine that is expected to remain in the long term. As medical schools adapt to the new face of medicine, students' transition to telemedicine should be prioritised, given that they have an important future role. Further efforts should focus on integrating telemedicine ET in tele-oncology services and educating students on using telemedicine systems. K.R. wrote the letter, and A.A. contributed to comments and editing. Tele-oncology in the COVID-19 Era: Are Medical Students Left Behind?: (Trends in Cancer 6:10, p:811–812, 2020)Rallis et al.Trends in CancerOctober 24, 2020In BriefIn this Letter article, the author's last name lacked a hyphen and therefore was incorrectly represented. The corrected author name is Andrea M. Allen-Tejerina. This has been corrected in the original online article. The authors apologize for this error. Full-Text PDF