Teleconsultation Competencies in Undergraduate Medical Education: A Critical Narrative Review and Evidence-Gap Analysis

Introduction

Teleconsultation has become an established form of healthcare delivery, moving beyond its applications as an emergency solution during the COVID-19 pandemic.^1–3 In many healthcare systems, teleconsultation is routinely used in primary care, specialist clinics, and follow-up medical services.^1,4,5 This shift has fundamentally changed the way clinical visits are conducted, introducing new organizational, communication, and ethical challenges that are distinct from those encountered during traditional face-to-face consultations.

Teleconsultations not only entail a change in the interaction environment but also a different clinical context that requires specific competencies.^5–11 Fundamental elements of medical practice, such as history-taking, clinical reasoning, shared decision-making, and professional communication, must be adapted to environments characterized by physical separation, limited nonverbal cues, and reliance on digital interfaces.^1,12–14 Teleconsultations offer a unique educational setting for developing clinical reasoning skills, as diagnostic decisions often must be made with limited opportunities for direct physical examination. This necessitates a greater reliance on structured history-taking and explicitly articulated reasoning. These conditions affect both the structure of the consultation and the dynamics of the interaction between the physician and the patient, particularly in relationship-building, situational awareness, and the interpretation of contextual cues.^15–18 Given the structure of teleconsultations, effective teleconsultation training may be most beneficial when learners have already acquired basic competencies in history-taking, physical examination, and clinical assessment.^19–22

Undergraduate medical education plays a key role in preparing future physicians for evolving forms of care.^20,21 Traditional curricula have been largely developed based on face-to-face clinical encounters with patients.^5,23–25 Medical interviews, along with unrestricted observation of nonverbal behaviors, informal contextual cues available in clinical settings, and direct physical examination, play key roles.^26,27 In classical and conservative educational models, students may begin clinical practice without being sufficiently prepared for the specific requirements of teleconsultation, despite demonstrating competence in conventional consultation.^28–33

Telemedicine education, telehealth education, and teleconsultation competency training are frequently used interchangeably in the literature, although they represent distinct educational constructs.^19,21 Telehealth and digital health curricula commonly include health informatics, remote monitoring, legal and ethical issues, digital systems, and technology-enabled care delivery. In contrast, teleconsultation competency training focuses specifically on remote clinical encounters between medical professionals and patients, including communication, clinical reasoning, consultation structure, virtual professionalism, and remote examination skills training.

Existing educational initiatives for teleconsultation training vary considerably in scope, pedagogical approaches, and target competencies.^22,34 Some programs emphasize technical aspects, such as platform use and medical records, whereas others focus on communication skills, clinical reasoning, and ethical issues.^19,34 However, the extent to which different teaching methods effectively support the acquisition of teleconsultation competencies remains unclear.^22,34 Furthermore, previous reviews in this field have often taken a descriptive approach, aggregating studies without distinguishing between skill areas, assessment strategies, and educational contexts. ³⁵

Therefore, a structured synthesis of the available evidence is needed to clarify which competencies are being taught, how they are assessed, and where the gaps in the literature are. Rather than evaluating technological solutions in isolation from the context, such a synthesis should focus on teaching teleconsultation as a complex educational and clinical practice that integrates communicative, cognitive, organizational, and professional dimensions.^36–38

An additional challenge is the place of teleconsultation training in undergraduate medical curricula. Many published educational initiatives have been implemented during the early years of medical education, including first-year and preclerkship education. While such approaches may increase familiarity with telemedicine and digital health concepts, teleconsultation differs from many introductory digital health topics because it relies heavily on pre-existing clinical competencies. Effective teleconsultation requires adapting history-taking, physical examination, clinical reasoning, and patient management skills to a remote environment, rather than replacing these competencies. Consequently, teleconsultation may not be viewed as a foundational competency but as an advanced clinical competency that builds upon prior experience in direct patient assessment and clinical decision-making.^33,34,39 This raises important questions regarding the optimal timing, sequencing, and integration of teleconsultation training into undergraduate medical education.

Despite the extensive literature on telemedicine, it is often regarded merely as a mode of care delivery or educational exposure rather than as a distinct clinical competency. This narrative review investigates the instruction of teleconsultation competencies and skills in medical education. The objectives of this review include identifying the competencies taught, the educational strategies used, and the methods used to assess learning outcomes. By mapping current approaches and identifying areas of convergence and limitations, this review seeks to provide valuable insights for curriculum development and support a more structured, competency-based integration of teleconsultation training into medical school curricula.

Based on the reviewed literature, teleconsultation competency was operationally defined as an integrated set of knowledge, skills, and professional behaviors required to conduct a safe, effective, patient-centered remote clinical consultation.

Methods

Results

AREAS OF COMPETENCE INCLUDED IN TELECONSULTATION TRAINING

The eligible studies identified in this review focused primarily on verbal communication skills, structured history-taking, clinical reasoning in virtual encounters, technical aspects of teleconsultation, and selected components of remote physical examination. These competency domains are frequently discussed in the broader telemedicine and telehealth education literature. An emphasis was placed on the clarity of questioning, logical sequencing of information, and explicit verbalization of clinical reasoning in situations where opportunities for direct physical examination are limited.

The broader literature highlights the importance of clinical reasoning in remote contexts, often through case-based discussions, simulated consultations, and structured virtual encounters. These educational approaches are intended to support hypothesis generation, prioritization of differential diagnoses, and decision-making in conditions of diagnostic uncertainty. Technical and organizational competencies, including the use of teleconsultation platforms, documentation practices, privacy considerations, and consultation management, are commonly described as foundational requirements for effective teleconsultation practice.

In contrast, nonverbal communication skills, including the interpretation of body language, facial expressions, and subtle interactional cues, have been addressed less consistently in the literature. Similarly, competencies related to empathy, relationship building, and the management of emotionally complex consultations are rarely the primary focus of educational interventions and remain challenging to teach and assess in remote settings.

Based on the identified evidence gaps and interpretive synthesis of the broader telemedicine and digital health education literature, we developed a preliminary teleconsultation competency framework for undergraduate medical education. The framework is organized around four core competency domains and a cross-cutting domain of professionalism and reflective practice ( Table 1 ). Additional details regarding the studies contributing to the broader interpretive synthesis are provided in Supplementary Table S1. The framework should be regarded as a conceptual and hypothesis-generating framework intended to support future curriculum development and empirical evaluation, rather than as a formally validated competency model.

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Table 1.

Proposed Teleconsultation Competency Framework for Undergraduate Medical Education

DOMAIN	BRIEF DESCRIPTION	KEY COMPETENCY ELEMENTS (EXAMPLES)	EXAMPLE TEACHING/LEARNING ACTIVITIES	EXAMPLE ASSESSMENT METHODS
Communication in virtual encounters	Patient-centered communication adapted to video/phone encounters	Structuring the virtual encounter; building rapport and trust online; explaining scope and limitations of teleconsultations; managing nonverbal cues and technical issues; safety-netting and closing	Simulated teleconsultations with SPs via video; role-plays; microteaching on “webside manner”; video review with feedback	OSCE teleconsultation station; structured communication checklists; mini-CEX in real/simulated televisits; SP ratings
Remote clinical reasoning and decision-making	Diagnostic reasoning and risk assessment under limited physical examination	Adapting history-taking to virtual context; formulating and revising differential diagnosis; deciding on remote versus in-person care; triage and escalation decisions; explicit safety planning	Case-based discussions using teleconsultation scenarios; virtual case conferences; use of decision algorithms/trees for remote care	Key-features or vignette-based tests; OSCE stations emphasizing disposition and safety-netting; chart-stimulated recall of virtual cases
Teleconsultation-adapted physical examination	Observation and guided self-examination to approximate an in-person examination	Guiding patients through simple maneuvers; optimizing camera and audio for examination; recognizing red-flag findings requiring in-person assessment; documenting limitations of virtual examination	Video-based skills labs; demonstrations with SPs using basic home equipment; peer rehearsal of examination instructions	OSCE station focused on teleconsultation-adapted physical examination; structured checklists; direct observation in simulated televisits
Technical, organizational, and legal–ethical competencies	Safe and effective use of teleconsultation platforms within organizational workflows	Basic platform operation and troubleshooting; identity verification and informed consent; privacy and confidentiality in remote settings; documentation and coding requirements; awareness of digital divide and access barriers	Platform onboarding workshops; briefings integrated into clinical skills courses; interprofessional sessions with IT and administration; seminars on guidelines and regulations	Multiple-choice questions/short-answer tests on technical and legal–ethical aspects; observed performance in simulated teleconsultations (e.g., consent, documentation); platform competency checklist
Professionalism and reflective practice (cross-cutting domain)	Professional identity, attitudes, and reflection specific to teleconsultations	Managing professional boundaries at a distance; maintaining empathy and respect online; responding to patient distress or complaints remotely; reflecting on quality, safety, and equity of teleconsultations	Reflective writing after simulated or real teleconsultations; debriefing sessions; guided peer feedback; and small-group discussions of challenging teleconsultation cases	Reflective portfolio entries; narrative faculty feedback; professionalism anchors in OSCE scoring; global rating scales of teleconsultation professionalism

Mini-CEX, Mini-Clinical Evaluation Exercise; SP, standardized patient; OSCE, Objective Structured Clinical Examination.

Discussion

The principal finding of this review is not the effectiveness of a specific educational intervention but the identification of multiple evidence gaps that currently limit the development, implementation, and evaluation of teleconsultation training in undergraduate medical education.

The identification of a single study that meets all predefined eligibility criteria should not be interpreted as a failure of the search strategies. Rather, it reflects the conceptual distinction adopted in this review between telemedicine-related educational exposure and explicit teleconsultation competency training. Many educational initiatives incorporate telemedicine into undergraduate education; however, most focus on communication skills, technology use, learner attitudes, or general telehealth exposure rather than conceptualizing teleconsultation as a comprehensive clinical competency with explicit learning objectives and measurable educational outcomes.^{28,33,34,40,41}

Although a substantial body of literature on telemedicine education exists, much of it focuses on learner attitudes, communication skills, virtual professionalism, technology use, and general exposure to telemedicine. A central finding of this review is that relatively few studies conceptualized teleconsultation as a comprehensive clinical competency that encompasses the full process of remote patient care. Consequently, the apparent abundance of telemedicine education studies may overestimate the extent to which undergraduate curricula prepare students to independently deliver telemedical care in the future.

The proposed teleconsultation competency framework ( Table 1 ) translates largely implicit expectations surrounding teleconsultation practice into explicit, teachable, and assessable competency domains for undergraduate medical education curricula.

Unlike broader telehealth competency frameworks, which frequently encompass digital systems, health informatics, legal issues, and population-level digital health concepts, the framework proposed in this review focuses specifically on the competencies required during remote clinical encounters. A complete teleconsultation requires the integration of history-taking, remote physical examination, clinical reasoning, risk assessment, management planning, and decisions regarding the need for in-person evaluation.^39–42 However, the literature reviewed suggests that communication-focused training is considerably more common than educational approaches that address the full scope of teleconsultation practice. This discrepancy is particularly relevant for specialties in which remote physical examinations contribute substantially to diagnostic decision-making, including musculoskeletal medicine, rehabilitation, neurology, dermatology, and primary care.

Teleconsultation is not simply communication through a digital platform; it is the remote execution of a clinical consultation, encompassing patient assessment, clinical reasoning, risk stratification, management planning, and decisions regarding the need for in-person evaluation.^39,40,42 Consequently, teleconsultation should be regarded as an extension of clinical competence rather than merely a digital communication skill.^39,42

Notably, the eligible studies incorporated communication, history-taking, clinical reasoning, and remote physical examination within a single educational intervention, illustrating the multidimensional nature of teleconsultation competency. Despite the growing adoption of teleconsultation in clinical practice, undergraduate curricula remain heterogeneous in terms of the competencies taught, educational strategies employed, and assessment approaches used.^42–46 Educational activities have focused on competencies aligned with remote consultations,^{15,16,37,38,47,48} particularly verbal communication, structured history-taking, and clinical reasoning articulation.^49–53 These skills benefit from the dialogic nature of teleconsultations, in which physicians rely on verbal interactions without direct physical examinations.^{18,37,44,54,55}

From an educational perspective, teleconsultation should not be viewed as a replacement for conventional clinical examination. Rather, it represents an advanced competency requiring learners to adapt previously acquired history-taking, physical examination, and clinical reasoning skills to a remote setting. Teaching teleconsultation before students have achieved basic proficiency in direct patient assessment risks reducing telemedicine education to communication training or platform familiarization while overlooking the broader clinical competencies required for safe and effective telemedical care.

This may partly explain why many published telemedicine curricula implemented during preclerkship training emphasize communication and technology use, whereas competencies requiring prior clinical experience, such as remote physical examination and teleconsultation-based clinical decision-making, remain less developed.

Teleconsultation training appears to be most meaningful when learners have already acquired foundational competencies in patient assessment, physical examination, and clinical reasoning.^33,34,56 In this context, teleconsultation functions as an extension of existing clinical competence, rather than as a substitute for conventional clinical training. This perspective may also help explain the predominance of communication-focused educational interventions in the literature, as more advanced competencies related to remote examination and teleconsultation-based decision-making require prior clinical experience and are therefore more difficult to integrate into early undergraduate curricula.

In contrast, competencies related to nonverbal communication, empathy, and the relational aspects of care have been addressed less consistently and often implicitly in the literature.^15,57–59 The limited availability of body signals, shared physical contexts, and opportunities for spontaneous human interaction pose challenges in teaching and assessing these skills in remote settings.^15,16,57 This imbalance raises concerns that an overreliance on teleconsultation-based teaching may not adequately prepare students for the full interpersonal demands of clinical practice unless supplemented by in-person educational experiences.^34,60,61

An important and closely related gap identified in this review concerns the teaching of physical examination skills adapted for remote consultations.^33,47,56,62 Although a few studies have included elements such as verbal cues, visual inspection, or patient-assisted activities, remote physical examination has rarely been considered a distinct competency with clearly defined teaching objectives or assessment strategies. This limitation is particularly relevant in specialties such as orthopedics, neurology, pediatrics, and rehabilitation medicine, where structured visual and functional assessments play key roles in clinical decision-making.^63–66 The lack of systematic educational approaches in this area suggests the need for clearer curriculum frameworks that explicitly include remote physical examination skills as an integral part of teleconsultation training.^33,34,47,56

The assessment practices used in various studies further limit the interpretability of the educational outcomes. Most studies relied primarily on self-assessment, including student satisfaction and perceived confidence levels.^33,34,41,56

Although these results provide valuable information about students’ experiences, they offer limited evidence of actual skill acquisition or transfer to clinical practice.^34,56 Observation- and outcome-based assessments were used less frequently and were not standardized, reducing comparability across studies and hindering evidence-based curriculum development. ⁵⁶

From the perspective of curricula, this review suggests that teleconsultation training should not replace traditional face-to-face consultations.^67–69 Rather, it serves as a complementary method to support teaching objectives, particularly for structured communication and cognitive processes.^34,60,70 Relational competencies and physical examination skills require special attention and cannot be adequately developed through teleconsultation teaching alone.^{34,42,54,71–73} The review findings should be interpreted with consideration of the limitations of the narrative synthesis. Although the heterogeneity of the research designs precludes formal comparisons of effectiveness, this review provides a structured overview. It identifies priority areas for future research, including competency frameworks, assessment strategies, and remote physical examination training methods to address these challenges.

If teleconsultation is regarded as a distinct clinical competency rather than simply a mode of digital communication, it has important implications for curriculum design. Teaching teleconsultation requires the structured development of competencies in patient assessment, remote examination, clinical reasoning, and clinical decision-making. These considerations form the basis of the recommendations presented below.

Limitations

This review has some limitations. First, it was designed as a critical narrative review rather than a systematic review or meta-analysis; therefore, its purpose was conceptual synthesis and evidence gap identification rather than exhaustive evidence mapping or quantitative evaluation of intervention effectiveness. Second, the eligibility criteria were intentionally restrictive, requiring studies to conceptualize teleconsultation as a distinct undergraduate clinical competency, describe an educational intervention, and report empirical outcomes. Only one study met all the predefined inclusion criteria. This limits the ability to draw conclusions regarding the comparative effectiveness of specific teaching methods.

Third, no formal risk-of-bias assessment was performed. This decision was consistent with the narrative and interpretive nature of the review and the very small number of eligible studies, but it limited the methodological appraisal of the available evidence. Fourth, the proposed competency framework was not developed through a formal Delphi process, a consensus workshop, or an external validation procedure. Therefore, it should be interpreted as a preliminary, hypothesis-generating framework that requires further refinement, validation, and testing in different undergraduate medical education contexts. Finally, because teleconsultation practices, regulatory requirements, digital infrastructure, and curricular structures vary across healthcare systems, implementing the proposed recommendations will require adaptation to local academic and clinical settings.

Conclusions

The principal finding of this review is not the identification of effective educational interventions but the recognition that teleconsultation remains insufficiently conceptualized as a distinct undergraduate clinical competency. Although telemedicine-related educational activities have been increasingly reported, many focus primarily on communication, technology use, or learner perceptions rather than on the full set of competencies required to safely deliver telemedical care.

This narrative review demonstrates that empirical evidence regarding the teaching of teleconsultation competencies in undergraduate medical education is limited. Although teleconsultation is becoming increasingly embedded in routine clinical practice, it is rarely addressed as a distinct competency with clearly defined learning objectives or assessment strategies at the undergraduate level of medical education.

These findings highlight the need for educational frameworks that explicitly define teleconsultation competencies, including communication in virtual encounters, clinical reasoning at a distance, technical aspects of teleconsultation, and structured approaches to remote physical examinations. Future research should focus on developing and evaluating such frameworks to align undergraduate medical education with contemporary healthcare models.

The principal challenge identified in this review is therefore not the absence of telemedicine education but the absence of coherent competency-based frameworks to prepare students for independent teleconsultation practice.

Authors’ Contributions

W.M.G.: Conceptualization, supervision, data curation, formal analysis, investigation, methodology, project administration, writing—original draft, and writing—review and editing. R.D. and T.C.: Investigation and writing—original draft. B.M.: Data curation and writing—review and editing. A.K.J.: Methodology, formal analysis, and writing—review and editing. A.Ś.: Formal analysis, visualization, supervision (supporting), and writing—review and editing.