Telehealth Competencies in Medical Education: New Frontiers in Faculty Development and Learner Assessments

Telemedicine visits requiring follow-up in-person visits at an urban academic family medicine centre

BACKGROUND

With the onset of the COVID-19 pandemic, telemedicine was rapidly implemented in care settings globally. To understand what factors affect the successful completion of telemedicine visits in our urban, academic family medicine clinic setting, we analysed telemedicine visits carried out during the pandemic.

METHODS

We conducted a retrospective chart review of telemedicine visits from 2 clinical units within a family medicine centre. To investigate the association between incomplete visits and various factors (age, gender, presenting complaints, physician level of training [resident or staff] and patient-physician relational continuity), we performed a multivariable logistic regression on data from August 2020, February 2021, and May 2021. An incomplete visit is one that requires a follow-up in-person visit with a physician within 3 days.

RESULTS

Of the 2,138 telemedicine patient visits we investigated, 9.6% were incomplete. Patients presenting with lumps and bumps (OR: 3.84, 95% CI: 1.44, 10.5), as well as those seen by resident physicians (OR: 1.77, 95% CI: 1.22, 2.56) had increased odds of incomplete visits. Telemedicine visits at the family medicine clinic (Site A) with registered patients had lower odds of incomplete visits (OR: 0.24, 95% CI: 0.15, 0.39) than those at the community clinic (Site B), which provides urgent/episodic care with no associated relational continuity between patients and physicians.

CONCLUSION

In our urban clinical setting, only a small minority of telemedicine visits required an in-person follow-up visit. This information may be useful in guiding approaches to triaging patients to telemedicine or standard in-person care.

Development of a Telehealth Simulation Using Intraprofessional Collaboration

ABSTRACT

Telehealth allows access to high-quality, holistic patient care, including diagnosis, interventions, treatments, monitoring, and patient education. As the use of telehealth continues to increase, faculty considered the need for entry-level nursing students to be introduced to telehealth and its services. Faculty from the medical-surgical II and mental health courses developed a learning experience for students that blends concepts from both courses, as patients often present with multiple problems. The telehealth experience helped students utilize assessment skills, learn delegation, and connect concepts from two courses to provide care for a patient remotely.

Roles and competencies of medical faculty members: A competency framework

PURPOSE

Medical education requires competent faculty members with the ability to create change in medical education. The focus on teacher competency are emerged as the results of medical education movements toward learner competency. The purpose of this study was to identify medical faculties competencies in their main roles and to provide a competency framework.

METHOD

The integrative review approach was utilized for identifying competencies and expert opinions was conducted to assigned competencies to roles and academic ranks. The search strategies were conducted in online databases including PubMed, Scopus, WOS and Eric to detect studies published from May 2003 to May 2023.

RESULTS

The identified competencies were classified to four themes including (1) essential personal competencies, (2) technical/functional competencies, (3) enabling competencies, and (4) meta-competencies.

CONCLUSION

According to the results, a competency framework was proposed which is a valuable tool for various important decisions related to faculty, such as promotions and tenurship.

Assessing Telemedicine Competencies: Developing and Validating Learner Measures for Simulation-Based Telemedicine Training

In 2021, the Association of American Medical Colleges published Telehealth Competencies Across the Learning Continuum, a roadmap for designing telemedicine curricula and evaluating learners. While this document advances educators' shared understanding of telemedicine's core content and performance expectations, it does not include turn-key-ready evaluation instruments. At the University of Oklahoma School of Community Medicine, we developed a year-long telemedicine curriculum for third-year medical and second-year physician assistant students. We used the AAMC framework to create program objectives and instructional simulations. We designed and piloted an assessment rubric for eight AAMC competencies to accompany the simulations. In this monograph, we describe the rubric development, scores for students participating in simulations, and results comparing inter-rater reliability between faculty and standardized patient evaluators. Our preliminary work suggests that our rubric provides a practical method for evaluating learners by faculty during telemedicine simulations. We also identified opportunities for additional reliability and validity testing.

Improving optometry student interpersonal skills through online patient, clinician and student evaluation and feedback

CLINICAL RELEVANCE

Interpersonal skills are crucial for successful clinician-patient interactions. To prepare future optometrists for clinical practice, pedagogical evaluation is important to support the implementation of new strategies for teaching and evaluating interpersonal skills.

BACKGROUND

Optometry students largely develop their interpersonal skills through in-person patient interactions. Telehealth is increasing, yet strategies to develop the interpersonal skills of students for teleconsulting have not been explored. This study aimed to assess the feasibility, effectiveness and perceived usefulness of an online, multisource (patients, clinicians and students) evaluation and feedback program for developing interpersonal skills.

METHODS

Via an online teleconferencing platform, optometry students (n = 40) interacted with a volunteer patient, observed by a teaching clinician. Patients and clinicians evaluated the interpersonal skills of the student in two ways: (1) qualitative written feedback, and (2) quantitative rating (Doctors' Interpersonal Skills Questionnaire). All students received written patient and clinician feedback after the session, but not their quantitative ratings. A subset of students (n = 19) completed two sessions, self-ratings, and were provided with their written feedback and an audiovisual recording from their first interaction before completing the second session. All participants were invited to complete an anonymous survey at program completion.

RESULTS

Patient and clinician overall interpersonal skills ratings were positively correlated (Spearman's r = 0.35, p = 0.03) and showed moderate agreement (Lin's concordance coefficient = 0.34). Student self-ratings did not match patient ratings (r = 0.01, p = 0.98), whereas there was moderate agreement between clinician and student ratings (Lin's concordance coefficient = 0.30). Ratings improved at the second visit (p = 0.01). Patient ratings were higher than clinicians (p = 0.01) and students (p = 0.03). All participants agreed that the program was feasible, useful and effective at fostering good interpersonal skills.

CONCLUSION

Multisource feedback about interpersonal skills contributes to improvement in student performance. Patients and clinicians can evaluate and provide useful feedback to optometry students about their interpersonal skills using online methods.

Online learning in health professions education. Part 2: Tools and practical application: AMEE Guide No. 163

Part 1 of the AMEE Guide Online learning in health professions education focused on foundational concepts such as theory, methods, and instructional design in online learning. Part 2 builds upon Part 1, introducing technology tools and applications of these foundational concepts by exploring the various levels (from beginner to advanced) of utilisation, while describing how their usage can transform Health Professions Education. This Part covers Learning Management Systems, infographics, podcasting, videos, websites, social media, online discussion forums, simulation, virtual patients, extended and virtual reality. Intertwined are other topics, such as online small group teaching, game-based learning, FOAM, online social and collaboration learning, and virtual care teaching. We end by discussing digital scholarship and emerging technologies. Combined with Part 1, the overall aim of Part 2 is to produce a comprehensive overview to help guide effective use online learning in Health Professions Education.

Digital learning about patients: An online survey of German medical students investigating learning strategies for family medical video consultations

Objective

Training in video consultations is seldom included in the curriculum for future physicians. Exploration of preferred teaching methods and learning objectives in this context among medical students remains limited. This study addresses this research gap by conducting a survey among medical students in Germany to assess their educational requirements concerning video consultations and patient-centred distance learning.

Methods

This quantitative study employed an online questionnaire designed for German medical students, following the guidelines of the International Association for Health Professions Education. The study primarily focused on discerning the didactic preferences related to patient-centred digital teaching regarding family medical video consultations. We provided a detailed explanation of a concrete learning concept, a family medical synchronous distance learning seminar. Subsequently, we surveyed students to gauge their needs, expectations, and evaluations of this concept. The collected data were subjected to descriptive analysis.

Results

The analysis revealed that students aspire to offer video consulting services to their patients in the future (sample size (n) = 369, median (med) = 68 of 101 Likert scale points, interquartile range (IQR) = 53.75), despite having limited knowledge in this area (n = 353, med = 21, IQR = 33.25). To acquire expertise in telehealth, students favor blended learning models (n = 331, med = 76, IQR = 50). They also recognize the benefits of distance learning, particularly for students with family responsibilities or those who must travel long distances to their learning institutions,. The presented distance seminar concept resonated with them (n = 278, med = 72.5, IQR = 50.5), surpassing five other digital learning models in preference. Furthermore, they expressed a desire for its continued implementation beyond the Coronavirus SARS-CoV-2 pandemic (n = 188, med = 77.5, IQR = 44.75).

Conclusions

The deficiency in medical school education regarding video consultations requires attention. This issue could be resolved by integrating one of the five distance learning concepts outlined in this article.

Telehealth Competencies: Training Physicians for a New Reality?

In North America, telehealth increased by 40% between 2019 and 2020 and stabilized at 40% in 2021. As telehealth becomes more common, it is essential to ensure that healthcare providers have the required skills to overcome the challenges and barriers of this new modality of care. While the COVID-19 pandemic has accelerated the design and implementation of telehealth curricula in healthcare education programs, its general adoption is still a major gap and an important barrier to ensuring scaling up and sustainability of the telesshealth practice. Lack of experienced faculty and limited curricular time are two of the most common barriers to expanding telehealth education. Overcoming the barriers of telehealth curricula implementation may require moving away from the classic expert model of learning in which novices learn from experts. As the adoption of telehealth curricula is still in its early stages, institutions may need to plan for faculty development and trainee education at the same time. Questions regarding the timing and content of telehealth education, the interprofessional development of curricula, and the identification of optimal pedagogical methods remain open and crucial. This article reflects on these questions and presents telesimulation as an ideal instructional method for the training of telehealth competencies. Telesimulation can provide opportunities for practical training across a range of telehealth competencies, fostering not only technical proficiency but also communication skills and interprofessional collaboration.

Microlearning and online simulation-based virtual consultation training module for the undergraduate medical curriculum - a preliminary evaluation

BACKGROUND

Virtual consultation is a synchronous mode of telemedicine provided remotely via information and communication technology. The projected growth of digitalization in healthcare delivery, however, necessitates medical student training in virtual consultation (VC) to ensure safe and effective patient care. This study describes the implementation and preliminary evaluation of a competency-based VC training module for undergraduate medical students.

METHODS

A newly developed six-week VC module was implemented online through asynchronous microlearning and synchronous simulation-based experiential learning modalities. Clinical students in years 4 and 5 and fresh graduates, who had not started pre-registration house officer or residency programmes, were invited to participate. Training outcomes using checklist-based video-recorded assessments of VC encounters between medical students and simulated patients were compared. Each video was independently assessed by two facilitators trained in VC teaching and assessment, using a direct observed virtual consultation skills checklist derived from established VC competencies. The participants completed course evaluations electronically as additional outcome measures.

RESULTS

Fifty-two clinical phase medical students and alumni completed both the instructional and practical phases of this module. Altogether, 45 (95.7%) students found the module beneficial, and 46 (95.9%) reported increased self-efficacy for conducting VC. In total, 46 (95.9%) students would recommend the course to others. Post-test results showed a significant increase in the students' abilities to conduct a VC (t-test = 16.33, p < 0.05).

CONCLUSION

Microlearning and simulation-based sessions were effective instructional delivery modalities for undergraduate medical students in their attainment of VC competencies.

Curriculum and Competency Evaluation in Respiratory Therapy Entry-to-Practice Programs

BACKGROUND

Essential skills for respiratory therapists extend beyond the traditional scope of therapy. Respiratory therapists are expected to communicate effectively, deliver bedside education, and practice within interprofessional teams. Respiratory therapy entry-to-practice program accreditation standards require evaluation of student competence in communication and interprofessional practice. This study aimed to determine if entry into practice programs include curriculum and competency evaluation for oral communication, patient education, telehealth, and interprofessional activities.

METHODS

The primary objective was to identify the curriculum and method of competency evaluation. The secondary objective was to compare degree programs. Directors of accredited respiratory therapy programs were invited to complete an anonymous survey with regard to degree program type, oral communication, patient education, learning strategies, telehealth, and interprofessional activities. Degree programs were classified as associate's of science 2 year, associate's of science < 2 year, or bachelor's of science.

RESULTS

Of 370 invited programs, respondents in 136 programs (37%) completed the survey. Oral communication competence was evaluated by 82%. Patient education curriculum and competency evaluation were reported by 86% and 73%, respectively. Telehealth was rarely included or evaluated. Interprofessional activities were included by 74%, of whom 67% evaluated competency. Bachelor's of science programs were more likely to include a specific patient education course (P = .004), evaluate oral communication competency with unpaid preceptors (P = .036), and evaluate interprofessional competence through formal interprofessional programs (P = .005). Associate's degree 2-year programs used laboratory proficiency for patient education competency evaluation more often than other programs (P = .01). associate's of science < 2-year programs were more likely to include simulation experiences that involved motivational interviewing (P = .01).

CONCLUSIONS

Differences exist among program types for curriculum and competency evaluation. Telehealth was rarely included or evaluated at any degree level. Programs should evaluate the need for enhanced patient education and telehealth instruction.

The Virtual Visit: A Telehealth Curriculum for Internal Medicine Residents Featuring a Virtual Physical Examination

Background

During the COVID-19 pandemic, medical professionals were obligated to adapt to virtual care. Most resident physicians had no formal telehealth training. The virtual physical examination remained underutilized.

Objective

We describe a needs assessment leading to the creation of a telehealth curriculum for internal medicine (IM) and internal medicine pediatric (IM/P) residents, and report changes in residents' confidence level as well as feasibility data. We hypothesized that residents' confidence in delivering virtual care would significantly improve after implementing a telehealth curriculum.

Methods

A needs-based assessment for all University of California Los Angeles (UCLA) IM and IM/P residents was conducted in July 2020. Specific competencies were identified: (1) telehealth legal guidelines; (2) virtual physical examination; (3) health equity; and (4) telehealth chronic disease management. The curriculum was presented via 3 synchronous interactive online interventions between November 2020 and March 2021. Pre- and post-intervention learner assessments were conducted.

Results

Out of all 180 residents, 146 UCLA IM and IM/P residents completed pre- and post-Virtual Physical Examination curriculum surveys, which were not uniquely linked to individuals. Residents reported statistically significant increased confidence levels in performing a targeted virtual physical examination (P<.001; 95% CI 0.97-1.35), engaging patients or caregivers to assist in virtual examinations (P<.001; 95% CI 0.76-1.21), and using remote monitoring devices (P<.001; 95% CI 0.58-1.03).

Conclusions

Our results demonstrate that, within our IM and IM/P residency programs, a formalized telehealth curriculum significantly improved residents' confidence in delivering virtual care.

A Qualitative Study on Using Telemedicine for Precepting and Teaching in the Academic Setting

PURPOSE

To examine the impact of telemedicine use on precepting and teaching among preceptors and patients during the COVID-19 pandemic.

METHOD

The authors conducted a secondary analysis of a qualitative study focusing on providers' and patients' experiences with and attitudes toward telemedicine at 4 academic health centers. Teaching and precepting were emergent codes from the data and organized into themes. Themes were mapped to domains from the 2009 Consolidated Framework for Implementation Research (CFIR), a framework that assists with effective implementation and consists of 5 domains: intervention characteristics, outer settings, inner settings, characteristics of individuals, and process.

RESULTS

In total, 86 interviews were conducted with 65 patients and 21 providers. Nine providers and 3 patients recounted descriptions related to teaching and precepting with telemedicine. Eight themes were identified, mapping across all 5 CFIR domains, with the majority of themes (n = 6) within the domains of characteristics of individuals, processes, and intervention characteristics. Providers and patients described how a lack of prepandemic telemedicine experience and inadequate processes in place to precept and teach with telemedicine affected the learning environment and perceived quality of care. They also discussed how telemedicine exacerbated existing difficulties in maintaining resident continuity. Providers described ways communication changed with telemedicine use during the pandemic, including having to wear masks while in the same room as the trainee and sitting closely to remain within range of the camera, as well as the benefit of observing trainees with the attending's camera off. Providers expressed a lack of protected structure and time for teaching and supervising with telemedicine, and a general view that telemedicine is here to stay.

CONCLUSIONS

Efforts should focus on increasing knowledge of telemedicine skills and improving processes to implement telemedicine in the teaching setting in order to best integrate it into undergraduate and graduate medical education.

Evaluating Modes of Observations Using Hierarchical Signal Detection Rater Models

Scoring of performance can be based on different modes of observation, which can include live and videotaped observations. Although live observations have been the traditional format of measuring examinee performance in education and in healthcare, videotaped observations provide educators and testing agencies the promise of unbiased and standardized evaluations, offering practical solutions to limitations of real-time scoring. This study proposes a measurement model taking into account different modes of observation, using an extension of the hierarchical rater model based on signal detection theory (HRM-SDT). A hierarchical rater model is motivated by the nested structure of scores assigned by raters - scores assigned by raters become indicators of performance quality, which in turn become indicators of examinee ability. This study extends the hierarchical structure of the scoring process to include modes of observation, which serves as an intermediary level between the latent categorical indicator of performance quality and examinee ability, forming a three-level HRM-SDT. Analyses based on real-world data showed differences in the quality of scores from live observations and videotaped recordings. Compared to the traditional HRM-SDT, the overall model fit improved when including modes of observation. Simulations using different sample sizes and conditions provide implications for uses of this model.

Telehealth outpatient palliative care in the COVID-19 pandemic: patient experience qualitative study

OBJECTIVES

Outpatient in-person early palliative care improves quality of life for patients with advanced cancer. The COVID-19 pandemic forced a rapid shift to telehealth visits; however, little is known about how telehealth in outpatient palliative care settings should be optimised beyond the pandemic. We aimed to explore, from the perspective of patients attending an outpatient palliative care clinic, the most appropriate model of care for in-person versus telehealth visits.

METHODS

A qualitative study using the grounded theory method. One-on-one, semistructured qualitative interviews were conducted with 26 patients attending an outpatient palliative care clinic at a tertiary cancer centre recruited from two groups: (1) those with >1 in-person appointment prior to 1 March 2020 and >1 telehealth appointment after this date (n=17); and (2) patients who had exclusively telehealth appointments (n=9). Purposive sampling was used to incorporate diverse perspectives.

RESULTS

Overall, participants endorsed a flexible hybrid approach incorporating both in-person and telehealth visits. Specific categories were: (1) in-person outpatient palliative care supported building interpersonal connections and trust; (2) telehealth palliative care facilitated greater efficiency, comfort and independence and (3) patient-preferred circumstances for in-person visits (preferred for initial consultations, visits where a physical examination may be required and advance care planning discussions), versus telehealth visits (preferred during periods of relative heath stability).

CONCLUSIONS

The elements of in-person and telehealth outpatient palliative care clinic visits described by patients as integral to their care may be used to develop models of hybrid outpatient palliative care delivery beyond the pandemic alongside reimbursement and regulatory guidelines.

Exploring the educational value of the general surgical outpatient clinic: a systematic review

Purpose

Optimising opportunities for exposure and learning in the clinical environment is a priority for surgical education. The surgical outpatient clinic provides a setting for engaging with the patient journey while gaining essential surgical knowledge and skills. This systematic review seeks to determine the role of the outpatient clinic in current surgical education for multiple levels of learners and identify strategies to improve educational utility.

Methods

A systematic search strategy was conducted across Medline (OVID), Embase, PubMed, and Web of Science databases according to PRISMA guidelines. A comprehensive grey literature search for evaluation of international postgraduate surgical curricula was also performed. Publications were included if they discussed or utilised the general surgical outpatient clinic in an educational context.

Results

Nine publications were included in this review. Educational interventions in a surgical outpatient clinic setting were discussed in three publications and two publications presented observational data relating to educational opportunities in the surgical outpatient clinic. Four postgraduate surgical curricula outlined the current approaches to surgical education in the outpatient clinic setting. Assessment of included studies by Kirkpatrick level of evidence highlighted that included studies did not investigate high-order educational outcomes. Thematic analysis of curricula was utilised to build a common set of learning outcomes.

Conclusions

Educational interventions were found to improve learning outcomes, particularly those that facilitated active student participation. Postgraduate surgical curricula utilise the surgical outpatient clinic and recognise its importance in surgical training through the implementation of outpatient-based learning objectives which serve as fundamental components of training. Common learning objectives can be used to direct further research into the efficacy of this educational context.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44186-023-00106-8.