Rapid Adoption of Telemedicine in Rheumatology Care During the COVID‐19 Pandemic Highlights Training and Supervision Concerns Among Rheumatology Trainees

Abstract

Objective To evaluate the impact of telemedicine use during the coronavirus disease 2019 (COVID‐19) pandemic on rheumatology trainees. Methods A voluntary, anonymous, web‐based survey was administered in English, Spanish, or French from August 19 to October 5, 2020. Adult and pediatric rheumatology trainees were invited to participate via social media and email. Using multiple‐choice questions and Likert scales, the survey assessed prior and current telemedicine use, impact on training, and supervision after COVID‐19 prompted rapid telemedicine implementation. Results Surveys were received from 302 trainees from 33 countries, with 83% in adult rheumatology training programs. Reported telemedicine use increased from 13% before the pandemic to 82% during the pandemic. United States trainees predominantly used video visits, whereas outside the United States telemedicine was predominantly audio only. Most (65%) evaluated new patients using telemedicine. More respondents were comfortable using telemedicine for follow‐up patients (69%) than for new patients (25%). Only 39% of respondents reported receiving telemedicine‐focused training, including instruction on software, clinical skills, and billing, whereas more than half of United States trainees (59%) had training. Postconsultation verbal discussion was the most frequent form of supervision; 24% reported no supervision. Trainees found that telemedicine negatively impacted supervision (50%) and the quality of clinical teaching received (70%), with only 9% reporting a positive impact. Conclusions Despite widespread uptake of telemedicine, a low proportion of trainees received telemedicine training, and many lacked comfort in evaluating patients, particularly new patients. Inadequate supervision and clinical teaching were areas of concern. If telemedicine remains in widespread use, ensuring appropriate trainee supervision and teaching should be prioritized.

Factors Associated With Telemedicine Use Among German General Practitioners and Rheumatologists: Secondary Analysis of Data From a Nationwide Survey

“…Because TM use is closely intertwined with physicians' knowledge in this domain, we strongly support the integration of digital competencies into medical education and offering of dedicated training courses for physicians [41][42][43]. Continuous education in this area seems to be particularly important, as telemedical options continuously increase, including not only medical apps but also completely new procedures such as patient self-sampling.…”

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

“…Conversely, these same studies have shown that online education struggles to find a balance between practical and theoretical learning; communication is often ineffective, and lessons are poorly optimized to the online environment. Furthermore, doctors in training report missing out on face-to-face interaction and networking opportunities and that some balance of online and in-person education would be optimal for future education [ 4 , 45 , 47 ].…”

“…It is not only the way education is accessed that has been altered by COVID-19, but also the type of education needed. A recent international report highlighted new training needs in telemedicine, showing that, despite widespread uptake of telemedicine, only 39% of rheumatology trainees received telemedicine training, and many reported feeling less comfortable when evaluating new patients or making treatment changes using telemedicine [ 4 ]. If telemedicine is to be incorporated into future models of care, appropriate training in virtual clinical skills will be necessary.…”

“…If telemedicine is to be incorporated into future models of care, appropriate training in virtual clinical skills will be necessary. Some suggest that this could include simulated virtual consultations and lessons in telemedicine-specific legislation [ 4 ]. Indeed, the United States Accreditation Council of Graduate Medical Education has already added telemedicine-specific competencies to its list of core competencies for medical training [ 4 , 14 , 48 ].…”

“…The coronavirus disease 2019 (COVID-19) pandemic led to challenges for the management of patients with RA. Public health initiatives forced rheumatologists to cancel or postpone in-person appointments and rapidly take on remote consultations and monitoring (telemedicine) [ 1 , 3 , 4 ]. As updated EULAR recommendations [ 5 ] came late in the first wave of the pandemic, rheumatologists had to adapt quickly and flexibly to a changing situation, often with minimal instruction.…”