Multi-Cohort Educational Process Evaluation of a Multiplatform Telemedicine System for Simulation-Based Gynecology Training

Telemedicine is increasingly relevant in undergraduate medical education; however, most educational studies emphasize short-term interventions, learner satisfaction, or tele-Objective Structured Clinical Examination performance rather than evidence derived from sustained platform implementation. This multi-cohort longitudinal implementation study evaluated a multiplatform asynchronous telemedicine system integrated into simulation-based gynecology training across three consecutive academic periods at a medical simulation center in Ecuador. Platform-generated teleconsultation records were analyzed at the record level, with repeated records nested within student identifiers when students submitted more than one case. Because the expected number of submissions differed across cohorts as part of planned curricular refinements, cohort-level differences were interpreted descriptively as implementation and process indicators rather than as comparative evidence of learner performance. A total of 205 teleconsultation records from 95 student users were analyzed. Documentation quality was high for current illness documentation (98.5%), physical examination documentation (87.3%), and physiologically plausible vital signs (74.1%). Specialist responses were linked to 196/205 records (95.6%), with complete structured feedback among linked responses. Faculty expert review and learner-reported perceptions provided complementary educational evidence, including perceived usefulness of specialist feedback for gynecology learning. These findings support the feasibility of asynchronous telemedicine-supported simulation workflows and the value of platform-generated data for educational process evaluation, documentation monitoring, and feedback tracking, while not demonstrating individual competence improvement.