Telephone Triage for Medical Students: An Exploration Through Cultural Historical Activity Theory

Telephone triage services are widely used in many countries, reflecting a broader shift towards remote patient consultations. Acknowledging this trend, we introduced a programme that placed medical students within a telephone triage service. We present this novel teaching intervention alongside an evaluation of student experiences.

Attendance at the 111 call centre was mandated for Year 5 medical students and was offered as an optional experience for Year 2 students. Students who had attended a call centre visit were invited to contribute to in-person focus groups. Three focus groups were conducted, involving 14 students. A semi-structured interview guide was employed and developed iteratively between focus groups. Data were analysed using thematic analysis. Findings were interpreted through the lens of cultural historical activity theory (CHAT).

Students developed an understanding of how uncertainty and risk are managed in information-sparse environments. Applying CHAT helped identify tensions within the activity system. These tensions were linked to the tools mediating their learning-specifically, decision-making algorithms and telephone consultations. Additional tension emerged around the underlying rules of the educational experience and the division of labour within the call-centre community, which often conflicted with final-year students' expectations and hindered their learning.

Students valued the opportunity to gain first-hand insight into telephone triage and its role within the health system. This setting may offer a useful perspective on managing uncertainty and risk in information-sparse environments. However, further research is needed to better understand how such placements can be optimised before wider educational adoption is recommended.