Implementing a telemedicine curriculum for internal medicine residents during a pandemic: the Cleveland Clinic experience

Abstract

Telemedicine training was not a substantial element of most residency programmes prior to the COVID-19 pandemic. Social distancing measures changed this. The Cleveland Clinic Internal Medicine Residency Programme (IMRP) is one of the largest programmes in the USA, which made the task of implementing a telemedicine curriculum more complex. Here we describe our experience implementing an effective, expedited telemedicine curriculum for our ambulatory resident clinics. This study was started in April 2020 when we implemented a resident-led curriculum and training programme for providing ambulatory telemedicine care. The curriculum was finalised in less than 5 weeks. It entailed introducing a formal training programme for residents, creating a resource guide for different video communication tools and training preceptors to safely supervise care in this new paradigm. Residents were surveyed before the curriculum to assess prior experience with telemedicine, and then afterward to assess the curriculum’s effectiveness. We also created a mini-CEX assessment for residents to solicit feedback on their performance during virtual appointments. Over 2000 virtual visits were performed by residents in a span of 10 weeks. Of 148 residents, 38% responded to the pre-participation survey. A majority had no prior telemedicine experience and expressed only slight comfort with the modality. Through collaboration with experienced residents and faculty, we expeditiously deployed an enhancement to our ambulatory care curriculum to teach residents how to provide virtual care and help faculty with supervision. We share our insights on this experience for other residency programmes to use.

How to incorporate telemedicine in medical residency: A Brazilian experience in pediatric emergency

“…There are some studies in the literature like ours, 7 , 8 , 9 , 10 such as the Cleveland Clinic experience 10 of a rotation in telemedicine for 148 Internal Medicine residents. It included training of preceptors and supervisors, interviews with residents before and after training, plus formative skills assessment (mini-CEX) and feedback after consultations.…”

“…The initial results showed good acceptance by residents, filling gaps in telehealth created by the COVID-19 pandemic and improvement of the program with criticism and suggestions from residents. 10 …”

Cultivating “Webside Manner” at the UME-GME Transition Point During the COVID-19 Pandemic: A Novel Virtual Telemedicine Curriculum

“…Many other programs in a variety of disciplines have piloted telemedicine training curricula for incoming residents as the need for this formalized education surged during the COVID-19 pandemic. [10][11][12] Our curriculum has given unique regard to training in privacy issues and virtual communication etiquette and is the only study to our knowledge which utilizes a control group to demonstrate the curriculum's efficacy. The results of this study demonstrate the effective role our formalized training played in the improvement of critical communication skills for telemedicine application on entry into residency.…”

Telerehabilitation as a Method for Achieving Competencies in Physical and Rehabilitation Medicine Residency Training in a Developing Country: A Protocol for a Pilot Mixed-Methods Study

“…In the future, the results of this pilot study can be used to come up with a larger study that involves all the other PRM training institutions in the Philippines. Nonetheless, it may be surmised that the residents may be able to improve their interpersonal and communication skills, medical knowledge, and even procedural skills through virtual patient encounters and didactics, as these are among the competencies expected in a telemedicine curriculum (12). In addition, through virtual care the residents may also be able to attain competencies in the other domains, such as patient safety and quality patient care, practiceand systems-based learning and improvement, reintegration of people with disabilities into the society, medical ethics and public health, quality assurance, policies of care and prevention for disabled people, and professionalism.…”

“…Specifically, knowing which aspects of the pre-pandemic curriculum can be taught through telerehabilitation can guide PRM educators and administrators in optimizing telerehabilitation as a teachinglearning method for residency training, augmenting traditional in-person mode of instruction. Curricular improvements can also consider the inclusion of PRM competencies specific to telemedicine, such as standard virtual communication, webside manners, remote physical examination techniques, utilization of various telemedicine technology platforms, and skills in documenting virtual encounters (12). These competencies may equip the modern generations of PRM graduates for a more competent and professional conduct of telerehabilitation, which can be leveraged especially during national or international crises disrupting in-person delivery of rehabilitation services and clinical training.…”