The birth of the virtual clinic: welcome to the Mediverse.

Abstract

The COVID-19 pandemic triggered a global pivot to virtual care (VC) technologies. While there has been considerable academic work exploring the "how" of VC, few studies have explored the impact of this pivot, its unintended consequences, and its governing rationales. This study addresses this gap in relation to care, professional identity and the evolving requirements for health professions education. Collected over three years, data for this study included evaluation surveys (134), interviews (59), publicly-available documents (240), and academic articles (217). Interviews and surveys were conducted in the Toronto Academic Health Science Network (TAHSN) and in a European academic medical centre (Maastricht UMC). Criteria for academic literature were that they addressed the shift to VC and were published between 2019 and 2023. Foucault's work, The Birth of the Clinic, his methodologies of Critical Discourse Analysis and his concept of spatiality, guided the analysis. Patients, clinicians and institutional leaders were appreciative of VC and the perceived improvements brought to care logistics, patient experience and efficiencies. Two discourses governed these sentiments-VC as a tool for both "service" and "managerialism." Assessing changes in clinical practice, experience and professional identity, our analysis suggested that a new virtual clinical space was being produced, one in which rules and experiences were different from that of a classical clinic. We named this new space the "Mediverse"-a space of undiscovered complexity with material and unintended consequences on user experience. This study identifies a new framework in which to study and assess this new clinical space.