The Virtual Neurologic Exam: Instructional Videos and Guidance for the COVID-19 Era

Hussona, Mariam Al; Maher, Monica; Chan, David W.; Micieli, Jonathan A.; Jain, Jennifer D.; Khosravani, Houman; Izenberg, Aaron; Kassardjian, Charles D.; Mitchell, Sara

doi:10.1017/cjn.2020.96

Cited by 83 publications

(106 citation statements)

References 9 publications

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“…Our introductory course therefore focused on video communication skills, the virtual physical examination, documentation changes and technology troubleshooting to help build resident competency in this new framework. Many recent articles detail best practices for the virtual physical examination, 11 and the neurological 12 and musculoskeletal 13 14 examinations in particular. One study showed non-inferiority of the virtual shoulder examination compared with the traditional ‘in person’ examination.…”

Section: Discussionmentioning

confidence: 99%

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

Savage

Gutiérrez

Montanè

et al. 2021

Postgraduate Medical Journal

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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.

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Section: Discussionmentioning

confidence: 99%

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

Savage

Gutiérrez

Montanè

et al. 2021

Postgraduate Medical Journal

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“…Telehealth is an expanding field with increasing understanding of what is possible through this medium for both acute and chronic consultations [ 43 ]. There are now several publications that describe a virtual neurologic examination [ 44 , 45 ]. There is also a growing number of publications addressing the possibility of virtual spine examination [ 46 , 47 , 48 ], although none of these virtual examinations have been studied for validity or reliability.…”

Section: Discussionmentioning

confidence: 99%

Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative

Haldeman¹,

Nordin²,

Tavares³

et al. 2021

JMIR Public Health Surveill

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Background The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient’s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

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“…Access to an online video library of patient encounters mitigated the loss of direct patient contact (Mian and Khan, 2020). Others have used videos to demonstrate clinical examination techniques (Al Hussona et al, 2020). Students were directed to large online resources such as YouTube videos and podcasts.…”

Section: Remedial Measuresmentioning

confidence: 99%

Engaging Medical Students During Covid-19 – Challenges and Novel Opportunities for Clinical Training

Mohideen¹

2020

SE Asian Jnl Med Educ

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Introduction: The COVID-19 pandemic has disrupted undergraduate clinical training in an unprecedented manner. With face-face student-patient interaction severely curtailed and hands-on training limited, the pandemic has upended experiential learning in a major way. Methods: The aim of this review was to examine the challenges faced and actions taken by medical schools and explore opportunities to overcome the loss of clinical training due to constrains by the public health measures to the COVID-19 crisis. The relevant literature was searched in PubMed, and Google Scholar using specific keywords, e.g., "COVID-19 "medical education," "challenges," and "opportunities." Results: Four themes were explored; initial response, mitigation measures, innovative solutions and future plans. Halting undergraduate clinical training was widespread except in a few countries where student's graduation was fast-tracked to serve the national healthcare workforce or assigned to nonclinical work. The loss of experiential learning was replaced by successfully transitioning to emergency remote online teaching through lectures, videos, quizzes and webinars. These are perceived as stopgap measures and falls short of replacing the authentic face to face learning in a clinical environment. Several innovative immersive methods were showcased using telehealth and virtual reality technologies and found to be useful and meaningful solutions to the loss of clinical interactions in the circumstances. Although these are attractive technological solutions, it is unlikely to be adopted in low resource setting until cost and training issues are resolved. Future plans will need to take the new-normal post covid environment into consideration and embrace the emergent technology to mitigate against further disruption. Conclusions: Significant widespread disruption to medical education has impacted clinical learning and delayed graduation. The rapid institutional response has mitigated the impact and kept students educationally engaged. The pandemic has highlighted that the immersive clinical experience in wards and interactive small group sessions are not easily replaceable. The challenge is to develop an innovative post-COVID medical education plan that will ensure a continuity in learning with academic competency.

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The Virtual Neurologic Exam: Instructional Videos and Guidance for the COVID-19 Era

Cited by 83 publications

References 9 publications

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

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

Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative

Engaging Medical Students During Covid-19 – Challenges and Novel Opportunities for Clinical Training

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