Telehealth for the internal medicine resident: A 3-year longitudinal curriculum

Abstract

Aims Across the United States of America, patients are increasingly receiving healthcare using innovative telehealth technologies. As healthcare continues to shift away from traditional office-based visits, providers face new challenges. Telehealth champions are needed to adapt technologies to meet the needs of patients, providers and communities, especially within the realm of primary care specialties. Given these challenges, this intervention aimed to incorporate telemedicine into internal medicine resident training across multiple training years to prepare them for practice in the current and changing healthcare system. Methods Education and telehealth leaders at the Medical University of South Carolina identified key topics relevant to telehealth and the provision of general internal medicine services. With this as a framework, we developed a 3-year longitudinal telehealth curriculum for internal medicine resident physicians, consisting of an introduction to telemedicine equipment in the first year, didactic learning through in-person education and online modules in the second year and experiential learning through remote monitoring of chronic disease in the third year. Participants included approximately 100 internal medicine residents per year (2016–2019). Self-perceived knowledge, comfort and ability to provide telehealth services was assessed via a survey completed before and after participation in the curriculum. Results Resident physicians’ self-reported knowledge of telehealth history, access to care, contributions of telehealth applications and quality of care and communication each improved after completion of the online curriculum. There were also significant improvements in resident comfort and perceived ability to provide telehealth services after participation in the curriculum, as assessed via a survey. Overall, 41% of residents felt their ability to utilize telehealth as part of their current or future practice was greater than average after completion of the online modules compared to only 2% at baseline ( p<0.01). Results also show residents accurately identify barriers to telehealth adoption at the healthcare system level, including the lack of clinical time to implement services (67% post- vs 47% pre-curriculum, p = 0.02), unfamiliarity with concepts (65% post- vs 21% pre-curriculum, p<−0.01) and concerns about consistent provider reimbursement (74% post- vs 39% pre-curriculum, p < 0.01). Conclusion Telemedicine and remote patient monitoring are an increasingly prevalent form of healthcare delivery. Internal medicine residents must be adept in caring for patients utilizing this technology. This curriculum was effective in improving resident comfort and self-efficacy in providing care through telehealth and provided residents with hands-on opportunities through supervised inclusion in remote patient-monitoring services. This curriculum model could be employed and evaluated within other internal medicine residency programmes to determine the feasibility at institutions with and without advanced telehealth centres.

Building Telemedicine Capacity for Trainees During the Novel Coronavirus Outbreak: a Case Study and Lessons Learned

“…In addition to practical guidelines for those undertaking telemedicine practice, there is urgent need for the rigorous translation and evaluation of "core" trainee competencies into virtual care environments. Until recently, the majority of telemedicine curricula and learner evaluation has focused on technical proficiency or adapted history and exam skills [18][19][20] . While domains such as professionalism, communication, and other interpersonal skills are often asked of evaluators as part of a general evaluation of trainees, these domains are rarely explicitly adapted to the virtual encounter.…”

Expanding Telehealth Competencies in Primary Care: A Longitudinal Interdisciplinary Simulation to Train Internal Medicine Residents in Complex Patient Care

“…9 A 3-year internal medicine telehealth curriculum provided online didactic content and experience in remote patient monitoring. 10 Lee et al also highlighted the importance of incorporating electronic consultation in graduate medical education to improve value-based access to specialty care. 11 Although objective structured clinical examinations (OSCEs) have been used in telehealth training, most interventions are limited to single encounter e-visits at the undergraduate medical level of training.…”

Evaluation and Feedback for Telehealth From Patients and Physicians During the Early Stage of COVID-19 Pandemic Period

“…Many residents at this clinic had no prior exposure to telehealth. A study by Kirkland and colleagues found that incorporating a three-year longitudinal telehealth curriculum for internal medicine resident physicians drastically improved resident comfort and ability to provide telehealth services [18]. This study and the low physician satisfaction with telehealth reveal the potential need to incorporate a telehealth curriculum into internal medicine resident training, especially in the COVID-19 era.…”