A Small Group Simulated Patient Telehealth Session on Taking a Medication History

This instructional activity is a 45-60-minute small group simulated patient telehealth session on taking a medication history that was adapted from an original in-person session in response to the COVID-19 pandemic and need for more virtual education. The instructional activity can be conducted via Zoom or another online platform. The session was designed for second-year medical students who were taking part in a geriatrics clinical skills session as part of our Physicianship curriculum. However, it is also appropriate for slightly more or less advanced learners and can readily be incorporated in other courses. 

Students prepared for the session by reviewing a study guide that addresses issues in all domains of the geriatric assessment (medical, functional, psychological, social, and economic) that students should consider when taking a medication history. In our modified session, a facilitator plays the role of Mr. or Mrs. Pat Parsec, a 75-year-old patient who is scheduled for a telehealth visit with a new primary care physician. The attending physician has asked the students to start the telehealth visit and complete three tasks that are aligned with the session’s learning objectives: 1) Take a medication history to gather information regarding the patient's understanding of their medications (e.g., indications, dosing, and side effects); 2) Identify medication concerns and factors influencing adherence; and 3) communicate a plan to the patient with steps that can be taken to reduce medication problems and obstacles to adherence. Some of the other challenges built in the case included multiple prescribers, therapeutic duplication, side effects, a medication without an indication, borrowed and shared medications, a complex medication regimen, an expensive medication, an expired medication, transportation challenges, and difficulty reading the labels and opening the bottles. 

At the time of the session, the overall session director reviews the learning objectives for the simulated patient activity and introduces the session format: 1) 15 minutes to ask the patient questions; 2) 10 minutes to review the medication labels, discuss medication issues and develop a plan to address these issues; 3) 10 minutes to communicate the plan back to the patient; and 4) 10 minutes for feedback and discussion. The students are then assigned to break-out rooms in groups of 4-6 with a facilitator who plays the role of the patient. Once the session is completed, student can be provided with a link to fill out a session evaluation form. Feedback from students (N=174) who participated in this session over the summer of 2020 was very positive (average of 4.8 on a 5-point Likert scale) and the session facilitators which included faculty, an advanced geriatric medicine fellow and fourth year medical students, indicated the sessions ran smoothly with only minimal technological difficulties (brief disconnections and sound issues) that were readily resolved.