JMIR Publications

ABSTRACT

Background:

Although neurology department ward rounds are among the most important medical education exercises in Japan, they have several issues. Patients may find it unpleasant to undergo repeated neurological tests, especially when in the presence of several students. Only the front row of students can closely observe the examination findings; moreover, students were prohibited contact with patients altogether during the coronavirus pandemic. One possible solution is to use commercial video conferencing systems. However, Japanese patients are reluctant to have their medical information or video footage of them sent outside of the hospital via the internet.

Objective:

The study aimed to confirm the feasibility of conducting remote teaching rounds using an in-house web conferencing system in which the patients' personal data are securely protected. This study also explored whether using remote rounds alongside face-to-face participation would enhance learning.

Methods:

We created an on-premises video-conferencing system using an open-source application. To perform video ward rounds, the professor wore a wireless microphone while leading routine in-person round and the attending physician carried a tablet device linked to a web conference, allowing students in another room to watch the rounds on a live-stream. In total, 112 5th-year students who entered their 1-week neurology rotation between 2021 and 2022 were instructed to participate in 1-hour rounds. During the rotation, they participated in in-person rounds for one patient who was assigned to them and viewed the rounds of several other patients on a large screen in another room. Students were given questionnaires to evaluate their satisfaction and the educational effects of the remote rounds.

Results:

The remote ward rounds were conducted easily with no interference with the in-person rounds, nor any complaints from the patients. Each examination technique was explained by another teacher to the students who participated in remote rounds in the conference room. Characteristic neurological findings, such as plantar reflexes (Babinski's sign), which are usually seen only by close observers during in-person rounds, could be visualized under magnification by all students. The post-experience survey (n=82/112, 73.2% response rate) revealed that 95.1% (78/82) of the students who participated in the remote rounds rated them better than good. The proportion of students who observed six representative abnormal neurological findings (Babinski's sign, hyperreflexia, cerebellar ataxia, involuntary movement, muscular weakness, and abnormality in sensory examination) increased by 24% (15.9%–25.2%) compared to in-person rounds alone. When self-rating the learning value, 42.7% (35/82) of the students answered that remote rounds are equally as valuable as in-person rounds, while 31.7% (26/82) preferred remote rounds.

Conclusions:

Live-streaming of neurology ward rounds using a secure in-house web conferencing system provides additional learning experience without concerns regarding leakage of patient information. This initiative could enhance neurology learning prior to entering clinical clerkship.