Teaching Medical Students to Use Telehealth Can Reduce Rural Health Inequities

Telehealth use has skyrocketed since the COVID-19 pandemic. Medical students have yet to be taught how to use it.

By Joy Lee

I got my first period when I was 12 years old. I was backstage of my middle school production of All Shook Up when I ran to the dressing room, panicked but not entirely unaware of what had just happened. I didn’t get another period for another two years, despite a frantic phone call with my mom and an emergency course on How to Use a Pad 101 taught by my pre-teen friends at the time. And, since then, I haven’t known when my next one will start. 

I was dealing with more than just irregular periods by the time I was in high school. I experienced rapid weight gain, skin discoloration, and other seemingly unrelated symptoms. I reached out to my pediatrician at the clinic of the rural community I grew up in. 

My treatment: birth control. 

This treatment provided me relief from unexpected periods, but it was merely a band-aid solution, offering a temporary reprieve without addressing the root cause of my symptoms. 

It wasn’t until the summer before my freshman year of college that I was diagnosed with Polycystic Ovarian Syndrome (PCOS) in South Korea, where I was able to receive a transvaginal ultrasound and specific bloodwork and had access to physicians who could diagnose and treat me accurately and effectively. 

I often wonder if I could have had an answer much earlier to all the abnormalities my body was facing if I had access to Telehealth growing up in my rural hometown. Maybe my earlier virtual consultations could have connected me with specialists or directed me to the right resources before my symptoms worsened. 

Telehealth could not have replaced the medical interventions I received in person, but it might have bridged the gap between my symptoms and the solutions I needed.

Addressing rural needs

The term “rural mortality penalty” was coined in 2008 in public health literature to describe the first perception of health disparities in rural communities in the 1980s. This term refers to the issue of rural residents not being able to access healthcare improvements that are present in urban areas. 

Rural communities face disproportionate burdens of preventable conditions such as obesity, diabetes, and cancer. Contributing factors include lower levels of physical activity and poor nutrition, coupled with limited access to healthcare services. One solution to this lack of access to healthcare exists: Telemedicine. To maximize its potential, standardized telemedicine curriculum should be created and implemented in medical schools in hopes of adequately equipping future doctors to provide care for rural communities. 

A review published in 2023 in Cureus addresses student curriculum in pre-clinical years. Students are heavily reliant on textbooks, lectures, and lab exercises to learn fundamental knowledge in the earlier years of medical school. Medical students could have access to a wealth of information that was not available before with an implementation of telemedicine curricula. Students can use the same resources to enhance their learning as well, through video conferences and collaborations with other medical colleges while learning how to provide care through learned telehealth skills and strategies.

Telehealth experienced major growth with its widespread implementation during COVID. After the pandemic, health systems in the US have increased the use of telehealth for postsurgical operation follow-ups, consults, and mental health visits, among others. Current barriers that don’t allow telehealth to be as effective include a lack of skills among providers. Providers inexperienced with telehealth care, for example, may struggle to obtain information from patients in a thorough manner, as opposed to an in-person visit.

The challenges of implementation

A paper written during the COVID-19 pandemic in the Journal of Medical Internet Research outlines how telemedicine curricula could be implemented. This report advocates for only slight adjustments to already-existing curricula. Currently, medical students are taught through the 13 Core Entrustable Professional Activities for entering residency (EPAs) created by the Association of American Medical Colleges. For each of these EPAs, the authors recommend a telemedicine approach that could teach medical students fundamental skills while allowing for virtual skill development. 

For example, EPA 11 states “Obtain informed consent for tests and/or procedures.” A telehealth-inclusive curriculum would allow students to assist with pre- and postoperative e-visits in surgery and obstetrics and gynecology. Medical students can participate and observe teleconsults. They could also collaborate in group discussions with other health-professional schools virtually, contributing to EPA 9, “collaborating as a member of an interprofessional team.” (4)

 Jodie Guest, PhD, who is Senior Vice Chair in the Department of Epidemiology at Emory University Rollins School of Public Health and the Associate Program Director for the Emory School of Medicine PA Program, has experience working with rural communities in Georgia. “I think (telehealth) is worth teaching,” Guest said. “Primarily what it should be is practicing the skills of (how to) connect with someone you know through electronic medium versus in person. It’s about practicing best practices and then actually going through and modeling that for the students.” 

Telemedicine offers a critical gateway for patients in rural areas to access diagnosis and potential treatment. Implementing a standardized telehealth curricula in medical schools can better equip future doctors to treat a wider range of patients. Current telehealth, however, has its limitations. 

Cassie Lewis Odahowski is a Research Assistant Professor who does works as a researcher at the Rural and Minority Health Research Center at the University of South Carolina. She works with the Cancer Prevention and Control Program within the Arnold School of Public Health,and has witnessed telehealth’s benefits, but also its downfalls, specifically in the diagnosis of cancer. 

“People don’t have access to primary care, family medicine, pediatricians in their communities, so rural people are less likely to meet preventive recommendations,” Odahowski said. “Preventative care and access to preventative care is a really important piece to early diagnosis of cancer, one of the biggest factors in survival.”

Although telehealth can be a bridge to diagnosis for people living in rural communities, access to telehealth itself remains a barrier. 

“I think that it (telehealth curriculum) should be included, because it’s not going to go away; it’s a part of our healthcare system, so we do need to discuss best practices for using telehealth,” Odahowski said. “[But] I don’t think that will be the total solution because there are issues around the ability of providers to have the access to platforms that are approved for telehealth use. There’s a cost associated with these platforms.” 

Odahowski further challenges to telehealth. Some providers who are in an older age group may not be comfortable with the technology required for telehealth. Additionally, some patients may not have access to broadband internet high enough in bandwidth to carry a telehealth call, even if a provider is comfortable and capable of providing care through a screen. Some states only allow live video calls with providers in the same state as their patient due to local policies, limiting access for some patients, especially those in lower income and rural populations. 

Those reasons are precisely why telehealth curriculum should be implemented now in medical schools. Teaching skills for future health professionals is a proactive approach, especially while providers triage how to better serve their patients through telehealth in the present.

Telehealth might have connected me to specialists or guided me to resources for my PCOS sooner, though telehealth alone could not have provided me a definite diagnosis. After all, the delays I experienced are not unique – many patients in rural areas face prolonged diagnostic journey due to limited access to care. 

The implementation of telehealth curricula in medical schools is a proactive step toward reducing health disparities in rural communities. Telemedicine cannot replace in-person care and has its own set of limitations, but it is already part of a growing healthcare delivery system. It is important that medical education makes changes to reflect this growth.