Training in Neurology: Adoption of resident teleneurology training in the wake of COVID-19

Abstract

The current COVID-19 pandemic has changed the way we engage patient care, with a move toward telemedicine-based healthcare encounters. Teleneurology is now being rapidly embraced by neurologists in clinics and hospitals nationwide but for many, this paradigm of care is unfamiliar. Exposure to telemedicine in neurology training programs is scarce despite previous calls to expand teleneurology education. Programs that do provide a teleneurology curriculum have demonstrated increased proficiency, accuracy, and post-training utilization among their trainees. With the current changes in healthcare, broad incorporation of teleneurology education in resident and fellow training after this pandemic dissipates will only serve to improve trainee preparedness for independent practice.The current COVID-19 pandemic is forcing a reckoning of current healthcare delivery and expediting a rapid transition to telemedicine-based care. Even in 2017, the Telemedicine Work Group of the American Academy of Neurology (AAN) recommended a teleneurology curriculum as an elective rotation for trainees1. How long ago 2017 seems now as we all hastily work to create operational teleneurology infrastructure in our clinics and hospitals. Although prior exposure in teleneurology is advantageous in tackling the complexities of moving to telehealth-based care, most of the neurology workforce is not formally trained in telemedicine. While we are far from fully understanding the long-term sequelae of this pandemic on our healthcare systems, broader exposure and increased comfort with teleneurology is imperative to prepare our trainees for the new world of medicine they will face after this current pandemic dissipates.

Best Practices for Integrating Medical Students Into Telehealth Visits

“…The literature describes various telehealth curricula for medical students [7,10,11,13] and residents [3,8,9,[20][21][22]. There has been an attempt to define both general [23] and discipline-specific telehealth competencies at the postgraduate level [8].…”

“…Telehealth or virtual visits are defined as live, synchronous, interactive encounters between a patient and a health care provider through video, telephone, or live chat [2]. The COVID-19 pandemic has greatly accelerated the use of telehealth visits to improve patient access to care and minimize risks to patients and health care providers [3,4], and even after the pandemic subsides, telehealth will remain an important and growing modality for care delivery [5]. The benefits of telehealth include increased access to care in remote or rural areas, mitigation of workforce shortages, improved chronic disease management, and improved health outcomes [6].…”

“…The 2015-2016 Liaison Committee on Medical Education Annual Medical School Questionnaire reported that over a quarter of US medical schools have implemented telehealth training in their preclinical curriculum and nearly half have implemented it in their clinical curriculum [7]. However, much of the existing literature on telehealth for learners focuses on residents [3,8,9] or telehealth curricular descriptions for medical students [7,[10][11][12][13]. There is limited but growing literature on integrating medical students into telehealth visits [14][15][16][17].…”

Training in Neurology: How Lessons Learned on Teaching, Well-being, and Telemedicine During the COVID-19 Pandemic Can Shape the Future of Neurology Education

“…The sudden adaptation of telemedicine actively involves trainees, and many of them recognized this benefit. Moreover, programs incorporating teleneurology teaching in the curriculum showed augmented proficiency and accuracy 15 .…”

“…Curricula incorporating changes as a reaction to a mutated clinical setting can provide a stronger, more authentic educational experience. Medical education research can evaluate the creation of milestones to be adapted to various environments 15 . Developing standardized, rigorous assessment and evaluation of telemedicine, via national and international collaborations, can guide curriculum review and trigger the definition of data safety regulations.…”