Openness toward the use of telemedicine among medical students in Romania: A cross-sectional study.

To the Editor: Telemedicine offered access to medical care throughout the COVID-19 pandemic, when in-person visits were restricted.,

Between May 20, 2021, and May 30, 2021, we performed a cross-sectional, online survey, using Google Forms, distributed among medical students attending the medical school at our university, regardless of the study year. This study was approved by the university’s ethical committee. Informed consent was obtained from participants. Answers were anonymous. Views assessing adequacy of dermatology for telemedicine were recorded as an ordinal 1- to 5-point scale, where 1 was attributed to “strongly disagree” and 5 to “strongly agree.”

Some of the survey questions were previously used in a study conducted by the same lead investigator (SC).

The aim of this study was to evaluate attitudes, beliefs, and behaviors in the study population since the beginning of the COVID-19 pandemic up to the moment of response to this questionnaire, an average period of 14 months.

Microsoft Excel 16 (Microsoft) and IBM SPSS, version 28 (IBM), were used for data analysis.

We recorded 200 answers; 33 incomplete answers were excluded. The remaining 167 were analyzed. The mean age was 23.86 ± 4.589 years, 77.8% (n = 130) were female, 96.4% (n = 161) lived in urban settings, and 30.5% (n = 51) considered specializing in dermatology. Data regarding the use of telemedicine and teledermatology are presented.

When questioned whether during the COVID-19 pandemic they or someone close needed medical assistance, 56.9% (n = 95) agreed, 41.9% (n = 70) denied, and 1.2% (n = 2) were unsure. Regarding whether they used telemedicine to receive medical care, 78.4% (n = 131) denied, 19.8% (n = 33) agreed, and 1.8% (n = 3) were unsure.

Regarding their opinion toward teledermatology consultation, 56.3% (n = 94) of 167 participants chose that they did not use this service. The results for the remaining 73 are detailed in Table I.

Table I

Reported perception, expectations regarding teledermatology and reasons for choosing it

N (%)
Total number of complete questionnaires167
Did you or someone close to you use telemedicine services to receive medical care?
Yes	33 (19.8%)
No	31 (78.4%)
Do not know	3 (1.8%)
What is your opinion on teledermatology consultations?
	Users of teledermatology expressing their belief28	Nonusers of teledermatology expressing their belief45
Very displeased	1 (3.6%)	0
Displeased	0	1 (2.2%)
Neutral	6 (21.4%)	30 (66.7%)
Pleased	16 (57.1%)	12 (26.7%)
Very pleased	5 (17.9%)	2 (4.4%)
How likely is it for you to choose telemedicine for a dermatologic condition rather than physical consultation?
	Users of teledermatology33	Nonusers of teledermatology134
Absolutely not	0	0
Unlikely	7 (21.2%)	61 (45.5%)
Possible	14 (42.4%)	55 (41.0%)
Very likely	9 (27.3%)	15 (11.2%)
Absolutely yes	3 (9.1%)	3 (2.2%)
What are your expectations regarding telemedicine services?
	Users of teledermatology33	Nonusers of teledermatology134
Efficient patient-physician communication	28 (84.8%)	105 (78.4%)
Prompt diagnosis and treatment	21 (63.6%)	64 (47.8%)
Short waiting time to consultation	28 (84.8%)	87 (64.9%)
The physician's increased attention to patient history	23 (69.7%)	81 (60.4%)
Receiving treatment immediately after consult, without a further visit being required	11 (33.3%)	27 (20.1%)
Which would be the reasons for using teledermatology instead of physical consultation?
	Users of teledermatology33	Nonusers of teledermatology134
Easy to get an appointment	25 (75.8%)	76 (56.7%)
As a way to prevent infection with the new coronavirus	12 (36.4%)	40 (29.9%)
The way in which the appointment takes place	14 (42.4%)	40 (29.9%)
As a way to avoid hospital anxiety or that caused by a physical consultation	5 (15.2%)	20 (14.9%)
For emergency situations, when in areas with unavailable medical services	27 (81.8%)	100 (74.6%)
What type of consultation would you prefer for teledermatology?
	Users of teledermatology33	Nonusers of teledermatology134
Live, real-time consultation	5 (15.2%)	44 (32.8%)
Store-and-forward consultation (a photo of the lesions is sent to a certain platform and afterward you wait for the result interpretation, followed by diagnosis and maybe treatment)	7 (21.2%)	12 (9.0%)
A combination of both of the above	21 (63.6%)	78 (58.2%)

Regarding teledermatology consultation types, from the 33 participants who had actually used teledermatology, 15.2% (n = 5) preferred real-time consultations, 21.2% (n = 7), store and forward, and 63.6% (n = 21), a combined approach.

When questioned about the future use of teledermatology, 40.1% (n = 67) agreed, 34.7% (n = 58) were undecided, and 25.1% (n = 42) disagreed.

From the 167 respondents, none fully excluded telemedicine over physical consultation for a dermatologic condition. Detailed analysis is presented in Table I.

Medical students are the future health care providers. They experienced this pandemic from a dual perspective, for first, the person involved in patient care and for second, the young adult in need to adapt to a new lifestyle with different rules and many restrictions.

As future doctors involved in patient triage and management, students’ perspective on the adequacy of dermatology for telemedicine compared to other specialties is important. Most considered it adequate, as 84.4% (n = 141) scored 3 or above.

Acne and atopic dermatitis were considered most suited for management through teledermatology. Data are shown in Table II.

Table II

Reported adequacy of dermatology for telemedicine and conditions considered suitable for management through teledermatology

Do you consider that dermatology is better suited for telemedicine compared to other specialties?
Total number of complete questionnaires N = 167	N (%)
1 Strongly disagree	3 (1.73)
2	23 (13.29)
3	51 (29.47)
4	58 (33.52)
5 Strongly agree	32 (18.49)
For which conditions would you choose teledermatology?
Total number of complete questionnaires N = 167	N (%)
Acne	136 (81.4)
Atopic dermatitis	98 (58.7)
Psoriasis	47 (28.1)
Atypical nevi	37 (22.2)
Bullous diseases	21 (12.6)
Seborrheic dermatitis	2 (1.2)
Viral warts	1 (0.6)
Impetigo	1 (0.6)
Skin care	1 (0.6)
Nail conditions	2 (1.2)
Tinea corporis	1 (0.6)

Without replacing physical consultation, telemedicine has shown great promise in times of epidemiological crisis. In some countries, it has become part of the training curriculum.

Our study found a moderate-to-high acceptability of telemedicine among Romanian medical students, many reporting that adequacy of dermatology for this approach is above that of other specialties.

Conflicts of interest

SC and AMG report no conflicts of interest. CMS declares the following, not related to the work: royalties from Springer Nature, consulting fees from Vichy International, and support for attending meetings from Leo Pharma.