“It Felt Like Practicing Telemedicine While Learning About It”: A Reflexive Thematic Analysis of Medical Students’ Reflective Diaries from a Telemedicine Elective Course Across two Cohorts

Abstract Background Telemedicine has shifted from a niche modality to an established component of routine clinical practice in many health systems. Medical curricula are only beginning to address this shift. Reflective writing is increasingly used both as a pedagogical tool in medical education and as a data source for qualitative research on student attitudes. The experiences and conceptual journeys of pre-clinical medical students enrolled in dedicated telemedicine instruction are under-studied, particularly across multiple cohorts spanning the COVID-19 and post-pandemic periods. Methods We conducted a reflexive thematic analysis of 81 reflective diaries written by students (predominantly second-year medical students) enrolled in an elective telemedicine course at a single Israeli medical school across two cohorts distinguished by consent procedure: a retrospective cohort (2019–2024, n = 39), in which students who had already submitted diaries as a routine course component were contacted by email in 2025 (after ethical approval was granted) and asked to consent retrospectively to use of their diaries in research; and a prospective cohort (2025, n = 42), in which students were informed at the start of the course that the diaries would be analyzed and were asked to enclose a signed consent form with the diary they submitted. Analysis followed Braun and Clarke’s six-phase reflexive thematic analytic framework with an inductive orientation. Results Six overarching themes were identified: (1) a transformative conceptual journey from skepticism or naïveté to conviction; (2) telemedicine as the inevitable trajectory of medicine and a site of professional-identity formation; (3) recognition of telemedicine as a holistic discipline drawing on multiple lenses; (4) a productive tension between equity gains and erosion of the doctor–patient bond; (5) lived experience (as patient, family member, or in prior professional roles) functioning as an explicit interpretive lens; and (6) pedagogy and the medium of delivery, with the Zoom format read by students as enacting the course’s argument. The thematic structure was stable across cohorts. Distributional shifts in the prospective (2025) cohort included articulation of artificial-intelligence displacement concerns, focused engagement with breaking-bad-news as a boundary case, named concerns about defensive prescribing, the war (October 2023 onward) as a catalyzing event alongside COVID-19, increased advocacy for converting the course from an elective to a curricular requirement, and emerging attention to online patient and clinician communities as a distinct dimension of digital medicine. Conclusions This multi-cohort qualitative analysis identifies six stable themes and documents strong, consistent positive engagement with a pre-clinical telemedicine elective across both cohorts. Students describe the course as a formative and highly valuable learning experience, engage substantively with the multi-dimensional character of telemedicine, and read the Zoom delivery format as enacting the course’s content — an effect we describe as pedagogical resonance. Differences in the articulation of certain sub-themes (notably AI-displacement concerns and humanistic boundary cases such as breaking bad news) were more prominent in the prospective (2025) cohort and reflect the evolving discourse on digital medicine; these are cross-sectional differences and do not warrant longitudinal or causal inference. Taken together, our findings make a strong case for the inclusion of dedicated telemedicine instruction as a core component of the pre-clinical medical curriculum.