Soon after the government decreed the quarantine due to the COVID-19 pandemic, our School of Medicine, like all the other institutions responsible for teaching at any level, was forced to keep active teaching for an indefinite but expectedly prolonged period. The urgent issue to solve was to continue with the educational tasks despite the impossibility of students to attend the health care centers were almost half of the subjects of the medical degree course are taught.

There is agreement that the aim of clinical education is learning of all types of competencies necessary for good medical practice. Each competence is made up of concepts, skills, abilities and attitudes in varying proportions. The interchange of experiences between trainers, students and often patients during face-to-face learning, which was interrupted by circumstances, is considered decisive to acquire most competencies. This forced those of us involved in educational management to sharpen our ingenuity to avoid the interruption of the medical career, but at the same time to guarantee that the students would meet the requirements of the curricula.

From the beginning of the pandemic, technology-mediated activities were implemented outside the classrooms, laboratories and health care centers, knowing that in most cases expository classes would predominate and would be very different from true distance education with computing platforms, forums, virtual classrooms, flipped classrooms, collaborative work, and intensive use of information and communication technologies (ICT), among others. Obviously, there were fewer difficulties in medical humanities, in which the contents and hands-on tasks in this modality were not very different from face-to-face classes. In morphology subjects, as Histology, the professors had no major problems because they shared screen with histology slides to illustrate the classes. In contrast, Anatomy required teachers’ creativity. They shared their screens with a combination of graphics and imagery of radiographies, computed tomography scans and magnetic resonance imaging, along with the visualization of the prominences and movements of some structures of their bodies, which the students mimicked at home on their own bodies. For clinical subjects, many computer platforms were offered and tested during the corresponding trial periods; however, the teachers expressed their preference for other strategies, as will be described below.

Certain hands-on activities, especially in the subjects Internal Medicine and Surgery, were carried out using the virtual modality to replace the face-to-face interaction between students and patients in health care centers and with the manikins in the skills laboratory, which was inactive due to official regulations. Similar virtual experiences were carried out by the professors of the two hospitals associated to Universidad de Ciencias Sociales y Empresariales (UCES), Juan A. Fernández and Bernardo Houssay, implemented in Internal Medicine and Surgery, respectively. The results of the former were reported during the Argentine Congress of Medical Education CAEM 2021¹. In addition, the students at their homes interviewed patients at the hospital via video calls using the screens and microphones of their cell phones, under the supervision of the teachers who were present in the hospital wards. The students indicated the relevant semiological maneuvers, requested complementary tests, interpreted the results, made diagnostic hypotheses and proposed therapeutic plans.

It is important to differentiate between the virtual patient and the simulated or standardized patient. Virtual patient is a computer software that simulates real life clinical scenarios and settings (doctor’s office, hospital ward or home) by using an avatar that represents a clinical case with its symptoms, signs, sociocultural environment and complementary tests. On the other hand, the standardized or simulated patient is a real person, who is trained, dressed and even made up to represent a specific disease, for the instruction and evaluation of clinical skills, reasoning, communication, attitudes and interpersonal bonds. These last three attributes make the difference with a virtual patient. An “avatar” such as the one mentioned by the authors of the article can overcome the deficiencies of the computing platform available, as the one we have used for testing purposes. As previously mentioned, our experience was carried out and is still being performed with standardized patients, who are actors extensively trained on aspects related with the disease based on a script. They not only simulate the corresponding symptoms and signs of the disease but they can also respond to the questions asked by the students with the appropriate coherence to provide the most plausible answers.

We celebrate that the authors of the article have clearly explained that the aims of the non-face-to-face educational strategy were the promotion of clinical reasoning and non-technical skills, deliberately excluding any reference to procedural aspects that require the use of skills².

Like in most other publications, the results were inferred from satisfaction surveys conducted among students. However, we have found an article from Universidad Nacional Autónoma de México (UNAM) which surveyed a small number of professors (Mercado Cruz et al.: Telesimulation: a strategy to develop clinical skills in medical students)³.

In our case, there was significant use of ICT for teacher-student interactions, both when using real or specially prepared medical records and in the cases in which actors were involved.

The quarantine served as an opportunity to intensify non-face-to-face practices that were already being carried out and which became the only possible way to practice during two school periods. Experience, permanent adjustments and contributions from teachers and students allowed us to improve them. The return to face-to-face teaching has not made us abandon them, but on the contrary, to lavish their use as a complementary and not alternative resource. We are aware that face-to-face teaching cannot be replaced by any modality that does not let students participate in clinical rotations or in the final practice in contact with the patient without losing educational quality.