The use of simulated telehealth patient encounters as a tool to teach first year medical students the HEADSS assessment and medical interviewing skills

Introduction: The HEADSS assessment is a medical interviewing tool used by physicians to obtain a psychosocial review of systems on adolescent patients. HEADSS is an acronym for the following important topics to be covered in the medical interview of an adolescent: Home, Education, Activities/Employment, Drugs, Suicidality and Sex. An in-person simulated patient experience using this tool was implemented during the MD1 course for JABSOM MD classes in 2016 as part of a student-led curricular development. At the time, the experience was perceived by both learners and volunteer “patients” to be of value for medical education. However, since 2020, the COVID-19 pandemic has required this experience be held over Zoom as a simulated telehealth patient encounter. This project aimed to assess whether this patient experience is still perceived as being useful for medical student education when conducted online.

Objective: The purpose of this study was to assess the utility of a simulated telehealth patient encounter in increasing medical students’ knowledge of the HEADSS assessment and medical interviewing skills.

Methods: After completing a 10-minute simulated telehealth patient encounter conducted over Zoom, first-year medical students were asked to complete a survey regarding their knowledge and opinions about the HEADSS assessment, medical interviewing, and telehealth both before and after the simulated experience.
Simulated patients were volunteer second-year medical students who had participated in the same simulation activity the year prior. Volunteers received a 1.5 hour training session and were provided a general script/scenarios to refer to during the encounter. First year students were first introduced to the HEADSS model through their curriculum and were asked to independently review the components of the model prior to the simulation. During the activity, students were asked to step in the role of a physician and could customize their application of the HEADSS model; while actors were instructed to respond in the way an adolescent would as suggested by the guidelines provided during training.
The primary objective of the simulation was to provide the first year students with the opportunity to practice establishing rapport with and collect a history from an “adolescent” patient through the use of open-ended questions and the HEADSS model.

Results: A total of 75 responses were obtained from a single medical school first year class. Over 82% of students responded “Strongly Agree” to the statement that the simulated experience helped to increase their understanding of the components of the HEADSS assessment. When compared to students’ responses before experiencing the simulated activity, there was significantly higher agreement with statements regarding 1) ability to select the appropriate types of questions to ask from the HEADSS assessment (p<0.001); 2) appreciation of the importance in balancing the medical interviewer’s agenda with that of the patient’s (p<0.001); and 3) importance of telehealth as a means for communicating with patients about their emotional health or mindset (p=0.001). The simulated activity did not have a significant impact on students’ perceptions of the importance of the role of telehealth in the future of medicine (p=0.288). Overall, 92% of students responded “Strongly Agree” to the statement that this activity should be continued for future medical school students.

Discussion: The results support the use of simulated patient activities as an effective teaching tool for clinically relevant/applicable models such as the HEADSS model as well as the fundamentals for medical interviewing. In comparison to their knowledge of the HEADSS assessment prior to the activity, the majority reported that the simulated activity did in fact increase their familiarity with the model. The majority of the students also noted that the simulation addressed an important component of medical interviewing – specifically the importance of balancing the agenda of the medical interviewer with the agenda of the patient. Overall, the results suggest that simulated patient activities delivered via videoconference technology can be useful for the specific topic used in this study and could therefore serve as an effective learning tool for other medical school curricula. Future studies could include expanding this experience to other medical schools, and also utilizing the simulated telehealth patient activity exercise to teach other medical communication skills.

Target Audience: Medical Educators and Medical Students