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Polavarapu M, Singh S, Sharma S, Hamilton G. Impact of telehealth on patient-provider communication in prenatal care for pregnant women from underserved settings. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024:1-9. [PMID: 38826111 DOI: 10.1080/17538068.2024.2360820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
INTRODUCTION Telehealth has emerged as a promising supplementary modality in prenatal care. However, its impact on patient-provider communication (PPC), especially among pregnant women from underserved settings, requires comprehensive evaluation. This study examined the factors associated with the quality of patient-provider communication during the COVID-19 pandemic among pregnant telehealth users and non-users. METHODS Using a cross-sectional study design, 242 women were surveyed (response rate = 23%) regarding their experience with telehealth, quality of PPC, and experiences of discrimination during prenatal care. Multiple regression models were used to identify the factors associated with the quality of PPC during the COVID-19 pandemic. A sub-group analysis explored the factors associated with the quality of PPC separately among telehealth users and non-users. RESULTS The majority of the participants were on Medicaid (95%) and self-identified as Black/African American (57.3%). Regression analyses revealed a negative relationship between telehealth use during pregnancy and the quality of PPC (β = -1.13, P = 0.002). Irrespective of the telehealth use, the experience of discrimination was associated with poor quality of PPC among users (β = -3.47, P = .02) and non-users (β = -.78, P = .03), while adjusting for sociodemographic factors and social support during pregnancy. DISCUSSION While telehealth offers advantages like convenience, increased accessibility, and continuity of care, challenges in establishing effective PPC in virtual settings have emerged that emphasize the necessity for comprehensive provider training extending beyond technical competencies. The persistent issue of perceived discrimination, impacting PPC across both groups, underscores the necessity to rethink existing strategies of mandatory training to increase providers' knowledge.
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Affiliation(s)
- Mounika Polavarapu
- Department of Population Health, The University of Toledo, Toledo, OH, USA
| | - Shipra Singh
- Department of Population Health, The University of Toledo, Toledo, OH, USA
| | - Shivangi Sharma
- College of Medicine, The University of Toledo, Toledo, OH, USA
| | - Grace Hamilton
- College of Medicine, The University of Toledo, Toledo, OH, USA
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Choi A, Murtha TD, Morrison LJ, Talwalkar JS. A Comparison Between In-Person and Virtual Communication Skills OSCE for Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241241375. [PMID: 38532857 PMCID: PMC10964456 DOI: 10.1177/23821205241241375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Abstract
Objectives This study investigates the effectiveness of a virtual format of an advanced communication skills observed structured clinical examination (OSCE) for senior medical students in comparison to an in-person format. The study also examines the emotional support students experience in the virtual setting. Our analysis was based on quantitative data collected through objective checklists and post-OSCE survey results. Methods The virtual OSCE was a revision of an earlier in-person formative advanced communication skills OSCE for fourth-year medical students. Student performances were assessed by self and peers using objective checklists-the modified Master Interview Rating Scale (mMIRS) and Communication Behavior Checklist (CBC). The mMIRS measured interview process such as avoiding jargon and demonstrating empathy. The CBC examined interview content which included tasks specific to the content of the case. The OSCE was followed by a faculty-led debrief and quantitative survey. The virtual OSCE was conducted in 2021, and the results of the checklists and survey were compared with those collected from two earlier in-person OSCEs. Results Eighty-three students participated in the virtual OSCE. There was no difference in mMIRS scores between the virtual and in-person OSCE. Overall CBC scores were lower in the virtual OSCE compared to in-person (p < 0.05). Sixty-seven out of 83 (80.7%) students completed the post-OSCE survey. There were no differences between the virtual and in-person OSCE in terms of educational value, whether the OSCE would change the way participants talk to patients, and preparedness to have serious conversations with patients. All respondents somewhat or strongly agreed with feeling emotionally supported during the virtual OSCE. Conclusion The virtual format was a suitable alternative to an in-person, formative, advanced communication skills OSCE for medical students. The virtual OSCE was educationally effective and was met with student satisfaction and a sense of emotional support. Future virtual iterations must ensure adequate instruction on interview content.
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Affiliation(s)
- Alex Choi
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tanya D. Murtha
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Jaideep S. Talwalkar
- Departments of Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Niehaus JZ, Slaven JE, Fettig L. Virtual Adaptation of Empathetic Communication Training for Pediatric Interns. Am J Hosp Palliat Care 2023; 40:1074-1078. [PMID: 36863861 DOI: 10.1177/10499091221145921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE Evaluate feasibility and effectiveness of virtual adaptation of in-person simulation-based empathetic communication training. METHODS Pediatric interns participated in virtual training session then completed post-session and 3 months follow up surveys. RESULTS Self-reported preparedness on the skills all improved significantly. The interns report the educational value as extremely high both immediately after and 3 months after training. 73% of the interns report using the skills at least weekly. CONCLUSION A 1 day virtual simulation-based communication training is feasible, well received, and similarly effective as in-person training.
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Affiliation(s)
- Jason Z Niehaus
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lyle Fettig
- Division of Hospice and Palliative Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Wilson LA, Harder B, Kelley C, Powell R, Foster M, Roberts E. Geriatric Telehealth: A Standardized Patient Case for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11345. [PMID: 37706040 PMCID: PMC10495538 DOI: 10.15766/mep_2374-8265.11345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/12/2023] [Indexed: 09/15/2023]
Abstract
Introduction The COVID-19 pandemic has necessitated the rapid expansion of telemedicine. However, there has been minimal coverage of telemedicine in traditional undergraduate medicine curricula. Telemedicine presents specific challenges in the geriatric population, including unfamiliarity with technology, cognitive and sensory barriers, inclusion of family and/or caregivers, multimorbidity, and a high degree of medical complexity. Methods We developed a workshop to allow rising third-year medical students to practice a telemedicine patient encounter while developing skills for assessing and communicating with geriatric patients. This 90-minute workshop consisted of an introductory didactic presentation and a standardized patient activity for small groups of two to five students. Students' level of comfort with telemedicine for assessment of geriatric patients was evaluated with a pre- and postsurvey. Results Fifty-eight students participated in the workshop and completed the surveys (presurvey = 58, postsurvey = 40), with roughly half (52%) reporting prior experience with telemedicine. A 5-point Likert-type scale (1 = very uncomfortable, 5 = very comfortable) was used. Students reported statistically significant increases in comfort using telemedicine (presurvey = 3.1, postsurvey = 3.9, p < .001) and using telemedicine for patients ≥65 years (presurvey = 2.8, postsurvey = 3.9, p < .001) after completing the workshop. Discussion Medical students' comfort levels using telemedicine and caring for patients ages 65 and older with a telehealth visit improved after participating in this workshop. To help prepare students for telehealth practice in their future careers, educators should provide them with opportunities to practice and develop this critical skill set.
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Affiliation(s)
- Lindsay A. Wilson
- Associate Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Brianna Harder
- Assistant Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Casey Kelley
- Research Assistant, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Ross Powell
- Resident Physician, Department of Internal Medicine, East Carolina University
| | - Megan Foster
- Resident Physician, Department of Family Medicine, University of Virginia School of Medicine
| | - Ellen Roberts
- Associate Professor, Division of Geriatrics, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
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Hayden EM, Nash CJ, Farrell SE. Simulated video-based telehealth training for emergency physicians. Front Med (Lausanne) 2023; 10:1223048. [PMID: 37700768 PMCID: PMC10494251 DOI: 10.3389/fmed.2023.1223048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction Little exists in the literature describing video-based telehealth training, especially for practicing Emergency Physicians. Materials and methods This was a retrospective, pre- and post-assessment of physicians' knowledge and confidence on video-based telehealth after two simulated telehealth encounters. Attending physicians voluntarily participated in Zoom-based trainings and received feedback from the patient actors immediately after each simulation. Post-experience surveys queried participants on the training, aspects of telehealth, and confidence in features of optimal telehealth practice. Results The survey had 100% response rate (13/13 physicians). Participants recommended the simulated training experience, mean of 8.38 (SD 1.89; 0 = Not at all likely, 10 = Extremely likely). Pre- and post-response means increased in two questions: "I can describe at least two ways to improve my video-based clinical care": delta: 1.54, t(12) = 3.83, p = 0.002, Cohen's d effect size of 1.06, and "I know when video-based telehealth could be helpful in clinical practice": delta: 0.99, t(12) = 3.09, p = 0.009, Cohen's d effect size of 0.86. Conclusion In this pilot, participants viewed telehealth more favorably after the experience and indicated improved confidence in focused telehealth skills. Further study is needed to determine what simulated case content provides the most value for decision-making via telehealth.
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Affiliation(s)
- Emily M. Hayden
- Department of Emergency Medicine, Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Christopher J. Nash
- Department of Emergency Medicine, Massachusetts General Hospital (MGH), Boston, MA, United States
| | - Susan E. Farrell
- Office of Medical Education, Harvard Medical School, Boston, MA, United States
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Wang SK, Goodrich RC, Strauss LD, Martindale JM. High-Yield, Case-Based, Interactive Workshop on Telehealth and Teleneurology With Pediatric Resident Physicians. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11340. [PMID: 37638232 PMCID: PMC10450098 DOI: 10.15766/mep_2374-8265.11340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/06/2023] [Indexed: 08/29/2023]
Abstract
Introduction Increasing prevalence of neurologic disorders with an aging global population and limited availability of neurologists may lead to worse patient outcomes. As a result of the COVID-19 pandemic, telehealth services surged, and despite easing public health measures, the demand has remained. Telehealth technology has the potential to close the physical gaps in expanding the reach of care. This academic half-day workshop sought to provide a learning opportunity in response to these concerns. Methods The workshop consisted of small- and large-group case discussions among pediatric resident physicians (PGY 1-PGY 3) moderated by two child neurology faculty physicians over Zoom. Participants received a learner document with prereading articles and questions for each case. PowerPoint presentations with video demonstrations were used to introduce the cases and guide discussions. Results Of the 25 attendees, 14 (56% response rate) answered a nonmandatory postsession survey. Eighty-six percent of the respondents were very or extremely satisfied with the content covered and were similarly satisfied with the effectiveness of content delivery. Seventy-nine percent of the respondents found the content helpful or very helpful in preparation for the board, and 93% anticipated applying the content covered occasionally or frequently in their clinical practice. Discussion Small-group discussions with video demonstrations are helpful in increasing proficiency with telehealth technology and in examining board-relevant cases on pediatric patients. There is strong interest in subsequent telehealth half-day workshops that incorporate teaching through group discussions on relevant patient case scenarios.
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Affiliation(s)
- Sean K. Wang
- Third-Year Medical Student, Wake Forest University School of Medicine
| | - Robert C. Goodrich
- Chief Resident, Department of Child Neurology, Atrium Health Wake Forest Baptist
| | - Lauren D. Strauss
- Associate Professor, Wake Forest University School of Medicine and Department of Neurology, Atrium Health Wake Forest Baptist
| | - Jaclyn M. Martindale
- Assistant Professor, Wake Forest University School of Medicine and Department of Neurology, Atrium Health Wake Forest Baptist
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Meshkin RS, Aziz K, Weinert MC, Lorch AC, Armstrong GW. Telemedicine Training in Ophthalmology Residency Programs. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e172-e174. [PMID: 37576804 PMCID: PMC10421718 DOI: 10.1055/s-0043-1772789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Ryan S. Meshkin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Kanza Aziz
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marguerite C. Weinert
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Alice C. Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Grayson W. Armstrong
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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El Kheir DYM, AlMasmoom NS, Eskander MK, Alshamrani RA, Alwohaibi RN, AlTheeb FN, Aleid BA. Perception of Saudi undergraduate medical students on telemedicine training and its implementation. J Family Community Med 2023; 30:231-238. [PMID: 37675211 PMCID: PMC10479026 DOI: 10.4103/jfcm.jfcm_41_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/19/2023] [Accepted: 05/14/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The use of telemedicine has increased considerably in healthcare delivery, especially during this time of the coronavirus disease 2019 (COVID-19) pandemic. It has, therefore, become necessary to train medical students to better equip them for this new means of healthcare delivery. The aim of the present study was to assess the perception of undergraduate medical students on telemedicine training. MATERIALS AND METHODS A cross-sectional study was conducted on a total of 521 undergraduate medical students studying in the Eastern Region of Saudi Arabia. Data were collected via a self-administered pretested questionnaire comprising two main sections: demographics and knowledge and opinions regarding telemedicine training. RESULTS About 73% students think that the use of telemedicine for patient care will increase in the future, and 59.3% think that the medical students should be trained in telemedicine. Majority of the students (78%) opined that telemedicine training should be optional and 58% said it should be taught during the clinical phase of the undergraduate curriculum. The best telemedicine training course learning objectives medical students opined to be included were: telemedicine practical skills (70.2%), legal aspects of telemedicine practice (68.3%), and potential positive and/or negative use of telemedicine tools and methods (67.6%). Telemedicine skills students would like to learn how to effectively engage patients, knowledge about telemedicine regulations and the consequences of breaching them. CONCLUSION Medical students are aware of the importance of incorporating telemedicine training into the medical curriculum. Training these students is vital to ensure their competence as physicians in their future clinical careers, that is make them a digitally health-literate future workforce.
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Affiliation(s)
- Dalia Y. M. El Kheir
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nour S. AlMasmoom
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mariam K. Eskander
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem A. Alshamrani
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rawaa N. Alwohaibi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah N. AlTheeb
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bedour A. Aleid
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Murphy EM, Stein A, Pahwa A, McGuire M, Kumra T. Improvement of Medical Student Performance in Telemedicine Standardized Patient Encounters Following an Educational Intervention. Fam Med 2023; 55:400-404. [PMID: 37307392 PMCID: PMC10622078 DOI: 10.22454/fammed.2023.523442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND OBJECTIVES The Association of American Medical Colleges identifies telemedicine competence as an important skill for graduating medical students, but which educational methods are effective in improving student performance is unclear. We aimed to assess the impact of two educational interventions on student performance in telemedicine standardized patient encounters. METHODS Sixty second-year medical students participated in the telemedicine curriculum during their required longitudinal ambulatory clerkship. Students first completed a preintervention telemedicine standardized patient (SP) encounter in October 2020. They subsequently were assigned to two intervention groups (ie, a role-play intervention, N=30; a faculty demonstration, N=30) and completed a teaching case. In December 2020, they completed a postintervention telemedicine SP encounter. Each case was a unique clinical scenario. SPs scored the encounters across six domains based on a standardized performance checklist. We compared the median scores for these domains and the median total score pre- and postintervention (using Wilcoxon signed rank and rank-sum tests) and the difference in median score by intervention type. RESULTS Students scored highly in history-taking and communication performance but had low physical exam (PE) and assessment/plan scores. Postintervention, median scores in PE (ie, median score difference 2, interquartile ranges [IQR] 1-3.5, P<.001), assessment/plan (ie, median score difference 0.5, IQR 0-2, P=.005), and overall performance improved significantly (ie, median score difference 3, IQR 0-5, P<.001). CONCLUSIONS Early medical students had low performance at baseline in telemedicine PE and assessment/plan skills, but both a role-play intervention and faculty demonstration led to significant increases in student performance.
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Affiliation(s)
- Emily M. Murphy
- Department of General Internal Medicine and Department of Pediatrics, Johns Hopkins University School of MedicineBaltimore, MD
| | - Ariella Stein
- Department of General Internal Medicine, Johns Hopkins University School of MedicineBaltimore, MD
| | - Amit Pahwa
- Department of General Internal Medicine and Department of Pediatrics, Johns Hopkins University School of MedicineBaltimore, MD
| | - Maura McGuire
- Department of General Internal Medicine, Johns Hopkins University School of MedicineBaltimore, MD
| | - Tina Kumra
- Department of Pediatrics, Johns Hopkins University School of MedicineBaltimore, MD
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Rueda AE, Monterrey AC, Wood M, Zuniga L, Rodriguez BDR. Resident Education and Virtual Medicine: A Faculty Development Session to Enhance Trainee Skills in the Realm of Telemedicine. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11302. [PMID: 36895763 PMCID: PMC9989055 DOI: 10.15766/mep_2374-8265.11302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/17/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION COVID-19 accelerated the use of telemedicine. Subsequently, clinical sites began conducting virtual visits. Academic institutions implemented telemedicine for patient care and simultaneously had to teach residents the logistics and best practices. To meet this need, we developed a training session for faculty focused on telemedicine best practices and teaching telemedicine in the pediatric realm. METHODS We designed this training session based on institutional and society guidelines and faculty experience with telemedicine. Objectives included telemedicine documentation, triage, counseling, and ethical issues in telemedicine. We conducted all sessions in a 60-minute or 90-minute format over a virtual platform for small and large groups using case scenarios with photos, videos, and interactive questions. A novel mnemonic ABLES (awake-background-lighting-exposure-sound) was created to guide providers during the virtual exam. Following the session, participants completed a survey evaluating content and presenter effectiveness. RESULTS We presented the training sessions between May 2020 and August 2021 to 120 participants. Participants included pediatric fellows and faculty, reaching 75 participants locally and 45 nationally (at Pediatric Academic Society and Association of Pediatric Program Directors meetings). Sixty evaluations (response rate: 50%) showed favorable results for general satisfaction and content. DISCUSSION This telemedicine training session was well received by pediatric providers and addressed the need for training faculty to teach telemedicine. Future directions include adapting the training session for medical students and developing a longitudinal curriculum that applies telehealth skills learned with patients in real time.
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Affiliation(s)
- Anna E. Rueda
- Assistant Professor, Division of Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine
| | - Ana C. Monterrey
- Assistant Professor, Division of Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine
| | - Margaret Wood
- Assistant Professor, Division of Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine
| | - Linessa Zuniga
- Assistant Professor, Division of Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine
| | - Betty Del Rio Rodriguez
- Assistant Professor, Division of Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine
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Adamkiewicz D, Atri L, Berman L, Broughton R, Jones C, Maslesa A, Lyon M. Implementation of a Telemedicine Student Clinical Experience. Telemed J E Health 2023; 29:432-441. [PMID: 35852847 DOI: 10.1089/tmj.2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background: As part of a curricular change, an academic medical center implemented a medical student telemedicine clinical experience for first-year medical students in October 2020. This research is a process evaluation of the implementation of a preclerkship medical student telemedicine clinical experience. Methods: Patients with two or more chronic diseases were recruited from affiliated primary care practices. We monitored the recruitment and retainment of patients throughout the curriculum. We used surveys to evaluate patient, student, and primary care overall experience with the program. We tracked referrals to higher levels of care and assessed skills students' felt they practice with each encounter. We followed progression of notes through chart review as the year progressed. Results: Of the 408 patients contacted, 150 agreed to participate in this program (36%). Of 1,053 scheduled visits, 686 (65%) were successfully completed. Seventy-five percent of patients were seen two or more times. Nearly 70% of surveyed patients felt that the clinical experience enhanced their communication with their primary care provider, and nearly 90% stated that students were "somewhat" or "extremely" professional. The majority (97%) of students reported an "excellent" or "good" view of the medical student telemedicine clinical experience. Qualitative measures of student performance, such as note writing, showed improvement over the course of the curriculum. Conclusions: Our data suggest that patients, students, and primary care providers were widely accepting of the curriculum, patients were successfully recruited and retained, and students successfully practiced key clinical skills on a telemedicine platform.
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Affiliation(s)
- Daniel Adamkiewicz
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Lavannya Atri
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Lindsay Berman
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Robert Broughton
- Department of Medicine and Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Cara Jones
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Ana Maslesa
- Center for Ultrasound Education, Augusta University Medical College of Georgia, Augusta, Georgia, USA
| | - Matthew Lyon
- Department of Emergency Medicine, Augusta University Medical College of Georgia, Augusta, Georgia, USA
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Silver SL. A Comparison of Family Medicine Resident Documentation Following Implementation of an Asynchronous vs Synchronous Telemedicine Curriculum. PRIMER (LEAWOOD, KAN.) 2022; 6:111327. [PMID: 36632496 PMCID: PMC9829010 DOI: 10.22454/primer.2022.111327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction Prior to the start of the 2020 COVID pandemic, the use of telemedicine among family physicians was limited; telemedicine curriculum in undergraduate and graduate medical education (GME) was even more scarce. In response to the need for training, we developed synchronous and asynchronous versions of a telemedicine curriculum focused on documentation, communication, and virtual physical exam. As the evaluation of the curriculum, this study compares the documentation behaviors of the clinicians participating in the curriculum. Methods We compared the documentation practice of asynchronous learners to those participating in synchronous learning over 1 month. We reviewed each clinical note for five practice behaviors: (1) consent for delivery of care via telemedicine, (2) time on the phone, (3) physical examination, (4) procedure code, and (5) billing code. Results We reviewed notes from 11 interns (synchronous) and 22 senior residents (asynchronous). Notes written by an intern were significantly more likely to include documentation of consent and a focused exam. Notes written by senior resident were significantly more likely to include documentation of length of the encounter. We detected no significant differences for documenting the billing or procedure code. Conclusion Our analysis determined that correct documentation behaviors can be taught through asynchronous mediums. Components requiring effective communication (consent for care and a virtual physical exam) are more effectively taught when there is deliberate practice and immediate feedback on the skills.
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Telemedicine to Expand Access to Critical Care Around the World. Crit Care Clin 2022; 38:809-826. [PMID: 36162912 DOI: 10.1016/j.ccc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This multiauthored communication gives a state-of-the-art global perspective on the increasing adoption of tele-critical care. Exponentially increasing sophistication in the deployment of Computers, Information, and Communication Technology has ensured extending the reach of limited intensivists virtually and reaching the unreached. Natural disasters, COVID-19 pandemic, and wars have made tele-intensive care a reality. Concerns and regulatory issues are being sorted out, cross-border cost-effective tele-critical care is steadily increasing Components to set up a tele-intensive care unit, and overcoming barriers is discussed. Importance of developing best practice guidelines and retraining is emphasized.
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Noronha C, Lo MC, Nikiforova T, Jones D, Nandiwada DR, Leung TI, Smith JE, Lee WW. Telehealth Competencies in Medical Education: New Frontiers in Faculty Development and Learner Assessments. J Gen Intern Med 2022; 37:3168-3173. [PMID: 35474505 PMCID: PMC9040701 DOI: 10.1007/s11606-022-07564-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
Telehealth visits have become an integral model of healthcare delivery since the COVID-19 pandemic. This rapid expansion of telehealthcare delivery has forced faculty development and trainee education in telehealth to occur simultaneously. In response, academic medical institutions have quickly implemented clinical training to teach digital health skills to providers across the medical education continuum. Yet, learners of all levels must still receive continual assessment and feedback on their skills to align with the telehealth competencies and milestones set forth by the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME). This paper discusses key educational needs and emerging areas for faculty development in telehealth teaching and assessment of telehealth competencies. It proposes strategies for the successful integration of the AAMC telehealth competencies and ACGME milestones into medical education, including skills in communication, data gathering, and patient safety with appropriate telehealth use. Direct observation tools in the paper offer educators novel instruments to assess telehealth competencies in medical students, residents, and peer faculty. The integration of AAMC and ACGME telehealth competencies and the new assessment tools in this paper provide a unique perspective to advance clinical practice and teaching skills in telehealthcare delivery.
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Affiliation(s)
- Craig Noronha
- Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Margaret C Lo
- Division of General Internal Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Danielle Jones
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Deepa Rani Nandiwada
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Tiffany I Leung
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Janeen E Smith
- San Francisco VA Health Care System, San Francisco, CA, USA.,Department of Medicine, University of California, San Francisco, CA, USA
| | - Wei Wei Lee
- Section of General Internal Medicine, University of Chicago Medical Center, Chicago, IL, USA.
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Yin L, Ng F, Rutherford-Rojas M, Williams M, Cornes S, Fernandez A, Garcia ME, Khoong EC. Assessing Medical Student Readiness to Navigate Language Barriers in Telehealth: Cross-sectional Survey Study. JMIR MEDICAL EDUCATION 2022; 8:e36096. [PMID: 35969421 PMCID: PMC9412902 DOI: 10.2196/36096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/10/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has greatly increased telehealth usage in the United States. Patients with limited English proficiency (LEP) face barriers to health care, which may be mitigated when providers work with professional interpreters. However, telehealth may exacerbate disparities if clinicians are not trained to work with interpreters in that setting. Although medical students are now involved in telehealth on an unprecedented scale, no educational innovations have been published that focus on digital care across language barriers. OBJECTIVE The aim of this study is to investigate advanced medical students' confidence in caring for patients with LEP during telehealth encounters. METHODS We administered a written survey to medical students on clinical clerkships at one US institution in August and September 2020. We assessed students' overall confidence in working with interpreters; confidence in performing 8 clinical tasks during in-person versus telehealth encounters; and frequency of performing 5 different clinical tasks with patients with LEP compared to English-speaking patients during in-person versus telehealth encounters. Wilcoxon signed-rank tests and chi-square tests were used to compare confidence and task performance frequency, respectively, for patients with LEP versus English-speaking patients during telehealth encounters. Students were also asked to identify barriers to care for patients with LEP. The free-response questions were qualitatively analyzed using open coding to identify key themes. RESULTS Of 300 medical students surveyed, 121 responded. Furthermore, 72 students answered >50% of questions and were included in the analyses. Compared to caring for patients with LEP during in-person encounters, respondents were less confident in working with interpreters (P<.001), developing trust (P<.001), identifying agenda (P=.005), eliciting preferences for diabetes management (P=.01), and empowering patients in lifestyle modifications (P=.04) during telehealth encounters. During both in-person and telehealth encounters, approximately half of students (40%-78%) reported engaging less frequently in every clinical task with patients with LEP and this was as low as 22% (13/59) for some tasks. Students identified these key barriers to care for patients with LEP: time pressure, interpretation quality and access, technical difficulties, cultural differences, and difficulty with rapport building. CONCLUSIONS Advanced medical students were significantly less confident caring for patients with LEP via telehealth than in person. Broader implementation of training around navigating language barriers is necessary for telehealth care, which has rapidly expanded in the United States. Our study identified potential key areas for curricular focus, including creating patient-centered agendas and management plans within the constraints of virtual settings. These developments must take place simultaneously with systems-level improvements in interpreter infrastructure to ensure high-quality care for linguistically diverse patients.
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Affiliation(s)
- Leena Yin
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Family Medicine, Swedish Cherry Hill Hospital, Seattle, WA, United States
| | - Fiona Ng
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mateo Rutherford-Rojas
- Interpreting, Translation and Language Services, UCSF Health, San Francisco, CA, United States
| | - Mia Williams
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Susannah Cornes
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Alicia Fernandez
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Maria E Garcia
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Multiethnic Health Equity Research Center, University of California, San Francisco, San Francisco, CA, United States
| | - Elaine C Khoong
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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16
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Wetzlmair LC, O'Carroll V, O'Malley AS, Murray S. Teleconsultation in health and social care professions education: A systematic review. CLINICAL TEACHER 2022; 19:e13519. [PMID: 35898157 PMCID: PMC9544545 DOI: 10.1111/tct.13519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
Abstract
Introduction Teleconsultation education in health care and social work education is under‐reported. However, literature indicates that educating the workforce in teleconsultation skills is essential to continue with safe, high‐quality delivery of services and increases the likelihood of implementing teleconsultations in health care. Training for students should, therefore, be encouraged. This systematic literature review aims to investigate global experiences of teleconsultation training in undergraduate health care and social work education. Methods A systematic review of peer‐reviewed literature was undertaken. The review was guided by the Joanna Briggs Institute guidelines. Electronic databases were searched for eligible evidence. Studies were included only if they described and evaluated teleconsultation education for undergraduate health care and social work students. Results/Discussion This review shows that mandatory education in teleconsultation is limited in undergraduate health care and social work education. Narrative synthesis and analysis of 14 studies led to the development of two themes: pedagogical aspects, and perspectives on telecommunication and teleconsultation learning and teaching. Practical experiences with simulated patients or during clinical placements with real patients were the most common mode of delivery. Feedback on teleconsultation education was generally positive; overall, health care students felt more confident using teleconsultation and valued safety of learning through simulation. Conclusion Teleconsultation education is a legitimate way to expose students to telehealth. High satisfaction rates, increased knowledge and confidence in use indicate the positive impact this learning has on students. Nevertheless, further high‐quality research and guidance for educators are warranted.
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Affiliation(s)
| | | | | | - Stuart Murray
- University of St Andrews, School of Medicine, St Andrews, UK
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17
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Bolster MB, Chandra S, Demaerschalk BM, Esper CD, Genkins JZ, Hayden EM, Tan-McGrory A, Schwamm LH. Crossing the Virtual Chasm: Practical Considerations for Rethinking Curriculum, Competency, and Culture in the Virtual Care Era. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:839-846. [PMID: 35263303 DOI: 10.1097/acm.0000000000004660] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Virtual care, introduced previously as a replacement for in-person visits, is now being integrated into clinical care delivery models to complement in-person visits. The COVID-19 pandemic sped up this process. The rapid uptake of virtual care at the start of the pandemic prevented educators from taking deliberate steps to design the foundational elements of the related learning environment, including workflow, competencies, and assessment methods. Educators must now pursue an informed and purposeful approach to design a curriculum and implement virtual care in the learning environment. Engaging learners in virtual care offers opportunities for novel ways to teach and assess their performance and to effectively integrate technology such that it is accessible and equitable. It also offers opportunities for learners to demonstrate professionalism in a virtual environment, to obtain a patient's history incorporating interpersonal and communication skills, to interact with multiple parties during a patient encounter (patient, caregiver, translator, telepresenter, faculty member), to enhance physical examination techniques via videoconferencing, and ideally to optimize demonstrations of empathy through "webside manner." Feedback and assessment, important features of training in any setting, must be timely, specific, and actionable in the new virtual care environment. Recognizing the importance of integrating virtual care into education, leaders from across the United States convened on September 10, 2020, for a symposium titled, "Crossing the Virtual Chasm: Rethinking Curriculum, Competency, and Culture in the Virtual Care Era." In this article, the authors share recommendations that came out of this symposium for the implementation of educational tools in the evolving virtual care environment. They present core competencies, assessment tools, precepting workflows, and technology to optimize the delivery of high-quality virtual care that is safe, timely, effective, efficient, equitable, and patient-centered.
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Affiliation(s)
- Marcy B Bolster
- M.B. Bolster is associate professor of medicine, Harvard Medical School, and director, Rheumatology Fellowship Training Program, Massachusetts General Hospital, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-5413-9345
| | - Shruti Chandra
- S. Chandra is assistant professor of emergency medicine, Thomas Jefferson University, director of Phase 3, Sidney Kimmel Medical College, and program director, Digital Health and Telehealth Education, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-0294-9397
| | - Bart M Demaerschalk
- B.M. Demaerschalk is professor of neurology, Mayo Clinic College of Medicine and Science, and medical director, Video Telemedicine Center for Connected Care and Center for Digital Health, Mayo Clinic, Phoenix, Arizona; ORCID: https://orcid.org/0000-0001-7262-817X
| | - Christine D Esper
- C.D. Esper is assistant professor of neurology, Emory University School of Medicine, and clinical director, Emory Brain Health Motion Capture Laboratory, Atlanta, Georgia; ORCID: https://orcid.org/0000-0002-1093-6537
| | - Julian Z Genkins
- J.Z. Genkins is a clinical informatics fellow, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0001-7673-8827
| | - Emily M Hayden
- E.M. Hayden is director of telehealth, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Aswita Tan-McGrory
- A. Tan-McGrory is director, Disparities Solutions Center, and administrative director, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Lee H Schwamm
- L.H. Schwamm is professor of neurology, Harvard Medical School, director, Center for TeleHealth, Massachusetts General Hospital and Harvard Medical School, and vice president, Digital Health Virtual Care, Mass General Brigham, Boston, Massachusetts
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18
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Kheir DYME, Alshamsi RA, Alalwi ST, Alshammari RZ. "Webside" healthcare from medical interns' perspective: Telemedicine implementation and need for training. J Family Community Med 2022; 29:145-154. [PMID: 35754750 PMCID: PMC9221231 DOI: 10.4103/jfcm.jfcm_105_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/03/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND: Telemedicine involves the use of electronic communication and technology to remotely deliver clinical services to patients. With the increase in the adoption of telemedicine in healthcare delivery, “webside healthcare” is becoming the virtual analog of bedside care. The Ministry of Health in Saudi Arabia has recently established the use of telemedicine, including social media (SM) and medical applications (Apps) to enhance the quality and accessibility of healthcare services to patients and healthcare providers. In the present study, we evaluated medical interns' perception of the use of telemedicine, SM, and medical Apps in patient care, their awareness of related guidelines to find out if targeted training is needed. MATERIALS AND METHODS: A qualitative study recruited and interviewed, through semi-structured key informant (KI) interviews and focus group discussions (FGD), a total of 24 male and female medical interns. The Interns were purposefully sampled from all Saudi Arabia's 5 main geographical regions until data saturation was observed. The transcripts of five KI interviews and 6 FGDs done were thematically analyzed and are presented as themes and subthemes. RESULTS: Medical interns discussed the advantages and disadvantages related to telemedicine, SM, and medical Apps in healthcare services. Overall, interviewees appreciated the role telemedicine, SM, and medical Apps play in the healthcare and for such particular specialties as family medicine and (tele-) psychiatry. However, the interns believed that training on the technical operational aspects of different telemedicine modalities with an emphasis on targeted education for related ethical and legal regulating guidelines was vital. CONCLUSION: Most interviewed medical interns had a positive perception of telemedicine and were willing to use it in their daily clinical practice. However, there were some challenges to its successful implementation such as prompt training on its proper use and clear ethical and legal guidance.
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Affiliation(s)
- Dalia Y M El Kheir
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Razan A Alshamsi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Sukainah T Alalwi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Razan Z Alshammari
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
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Khan S, Llinas EJ, Danoff SK, Llinas RH, Marsh EB. The telemedicine experience: using principles of clinical excellence to identify disparities and optimize care. Medicine (Baltimore) 2022; 101:e29017. [PMID: 35451400 PMCID: PMC8913094 DOI: 10.1097/md.0000000000029017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/17/2022] [Indexed: 01/04/2023] Open
Abstract
The use of telemedicine has increased significantly during the Corona virus disease 2019 pandemic. This manuscript serves to identify the underlying principles of clinical excellence in telemedicine and to determine whether effective care practices can be generalized as a one-size-fits-all model or must instead be tailored to individual patient populations.A survey assessing care quality and patient satisfaction for patients using telemedicine was created and administered via email to 2 urban cohorts of varying demographics and socioeconomic backgrounds: a population of patients with prior stroke and cerebrovascular disease, and a cohort of patients followed for interstitial lung disease. Results were compared across groups to determine the generalizability of effective practices across populations.Individuals taking part in telemedicine were more likely to be White, more affluent, and woman, regardless of clinical diagnosis compared with a similar cohort of patients seen in-person the year prior. A lower-than-expected number of patients who were Black and of lower socioeconomic status followed up virtually, indicating potential barriers to access. Overall, patients who participated in televisits were satisfied with the experience and felt that the care met their medical needs; however, those who were older were more likely to experience technical difficulties and prefer in-person visits, while those with less education were less likely to feel that their questions were addressed in an understandable way.When thoughtfully designed, telemedicine practices can be an effective model for patient care, though implementation must consider population characteristics including age, education, and socioeconomic status, and strategies such as ease of access versus optimization of communication strategies should be tailored to meet individual patient needs.
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Affiliation(s)
- Sheena Khan
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Edward J. Llinas
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Sonye K. Danoff
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Rafael H. Llinas
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Elisabeth B. Marsh
- Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, MD
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Aziz K, Sherif NA, Meshkin RS, Lorch AC, Armstrong GW. Telemedicine Curriculum in an Ophthalmology Residency Program. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0042-1743580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Background The COVID-19 pandemic has accelerated the adoption of telemedicine in the field of ophthalmology. Despite the increasing utilization of telemedicine, there is a lack of formal training in ophthalmology residency programs to ensure ophthalmologists are prepared to conduct virtual eye exams.
Objective This article aims to assess the impact of an ophthalmic telemedicine curriculum on ophthalmology residents' self-reported knowledge acquisition in conducting telemedicine eye exams, perceived ability to diagnose, manage, and triage common eye diseases, and evaluate their attitudes toward the current and future use of teleophthalmology.
Methods This single-center study at Massachusetts Eye and Ear used a nonvalidated pre- and postcurriculum survey conducted during the 2020 to 2021 academic year among ophthalmology residents. Participants engaged in an ophthalmic telemedicine curriculum that consisted of interactive didactic lectures and electronic postdidactic assessments.
Results Twenty-four residents (100%) completed a precurriculum survey, while 23 of 24 (95.8%) residents completed both the telemedicine curriculum and a postcurriculum survey. On a five-point Likert scale, the median interquartile range (IQR) scores for confidence with setup/logistics, history taking, examination, documentation, and education increased from 2.5 (2.0–4.0) to 4.0 (3.5–4.5) (p = 0.001), 3.0 (3.0–4.0) to 5.0 (4.0–5.0) (p < 0.001), 2.0 (1.8–2.0) to 4.0 (3.5–4.0) (p < 0.001), 2.0 (1.0–2.0) to 4.0 (3.0–4.0) (p < 0.001), and 2.5 (2.0–3.0) to 4.0 (4.0–4.0) (p < 0.001), respectively. The median (IQR) scores for comfort with ethics/professionalism, disparities and conducting patient triage, diagnosis, and management increased from 2.0 (2.0–2.3) to 4.0 (3.0–4.0) (p < 0.001), 2.0 (2.0–2.0) to 3.0 (3.0–4.0) (p < 0.001) and 3.0 (2.0–3.0) to 4.0 (3.0–4.0) (p = 0.001), 2.0 (2.0–3.0) to 3.0 (3.0–4.0) (p < 0.001), and 3.0 (2.0–3.0) to 3.0 (3.0–4.0) (p = 0.008), respectively.
Conclusion The implementation of an ophthalmic telemedicine curriculum increased resident confidence and self-reported knowledge across all logistical and clinical components of virtual ophthalmic care. Formal telehealth curricula can address an unmet educational need of resident trainees in an era of rapid uptake and utilization of telehealth services.
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Affiliation(s)
- Kanza Aziz
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Noha A. Sherif
- The University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ryan S. Meshkin
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Alice C. Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
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Poluch M, Feingold-Link J, Ankam N, Kilpatrick J, Cameron K, Chandra S, Doty A, Klein M, McCarthy D, Rising K, Salzman D, Ziring D, Papanagnou D. I Don't Have a Diagnosis for You: Preparing Medical Students to Communicate Diagnostic Uncertainty in the Emergency Department. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11218. [PMID: 35178469 PMCID: PMC8814030 DOI: 10.15766/mep_2374-8265.11218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Diagnostic uncertainty abounds in medicine, and communication of that uncertainty is critical to the delivery of high-quality patient care. While there has been training in communicating diagnostic uncertainty directed towards residents, a gap remains in preparing medical students to understand and communicate diagnostic uncertainty. We developed a session to introduce medical students to diagnostic uncertainty and to practice communicating uncertainty using a checklist during role-play patient conversations. METHODS This virtual session was conducted for third-year medical students at the conclusion of their core clerkships. It consisted of prework, didactic lecture, peer role-play, and debriefing. The prework included reflection prompts and an interactive online module. The role-play featured a patient complaining of abdominal pain being discharged from the emergency department without a confirmed diagnosis. Students participated in the role of patient, provider, or observer. RESULTS Data from an anonymous postsession survey (76% response rate; 202 of 265 students) indicated that most students (82%; 152 of 185) felt more comfortable communicating diagnostic uncertainty after the session. A majority (83%; 166 of 201) indicated the session was useful, and most (81%; 149 of 184) indicated it should be included in the curriculum. DISCUSSION This virtual session requires few facilitators; has peer role-play, eliminating the need for standardized patients; and is adaptable for in-person teaching. As its goal was to introduce an approach to communicating diagnostic uncertainty, not achieve mastery, students were not individually assessed for proficiency using the Uncertainty Communication Checklist. Students felt the session intervention was valuable.
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Affiliation(s)
- Maria Poluch
- Medical Student, Sidney Kimmel Medical College at Thomas Jefferson University
| | | | - Nethra Ankam
- Associate Professor, Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Jared Kilpatrick
- Medical Education Fellow, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Kenzie Cameron
- Research Professor, Division of General Internal Medicine and Geriatrics, Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Shruti Chandra
- Associate Professor, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Amanda Doty
- Research Coordinator, Department of Emergency Medicine, Thomas Jefferson University
| | - Matthew Klein
- Assistant Professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine
| | - Danielle McCarthy
- Associate Professor, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine
| | - Kristin Rising
- Associate Professor and Director of Acute Care Transitions, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University
| | - David Salzman
- Associate Professor, Department of Emergency Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Deborah Ziring
- Clinical Associate Professor, Department of Medicine, and Senior Associate Dean for Academic Affairs, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Dimitrios Papanagnou
- Professor and Vice Chair for Education, Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University; Macy Faculty Scholar, Josiah Macy Jr. Foundation
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Bouamra B, Chakroun K, Medeiros De Bustos E, Dobson J, Rouge JA, Moulin T. Simulation-Based Teaching of Telemedicine for Future Users of Teleconsultation and Tele-Expertise: Feasibility Study. JMIR MEDICAL EDUCATION 2021; 7:e30440. [PMID: 34941553 PMCID: PMC8734919 DOI: 10.2196/30440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Health care professionals worldwide are increasingly using telemedicine in their daily clinical practice. However, there is still a lack of dedicated education and training even though it is needed to improve the quality of the diverse range of telemedicine activities. Simulation-based training may be a useful tool in telemedicine education and training delivery. OBJECTIVE This study aims to assess the feasibility and acceptability of simulation-based telemedicine training. METHODS We assessed five telemedicine training sessions conducted in a simulation laboratory. The training was focused on video teleconsultations between a patient and a health care professional. The assessment included the participants' satisfaction and attitudes toward the training. RESULTS We included 29 participants in total. Participant satisfaction was high (mean score 4.9 of 5), and those that took part stated the high applicability of the simulation-based training to their telemedicine practices (mean score 4.6 of 5). They also stated that they intended to use telemedicine in the future (mean score 4.5 of 5). CONCLUSIONS Simulation-based training of telemedicine dedicated to video teleconsultation was feasible and showed high satisfaction from participants. However, it remains difficult to scale for a high number of health care professionals.
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Affiliation(s)
- Benjamin Bouamra
- Department of Neurology, Besançon University Hospital, Besançon, France
| | - Karim Chakroun
- Department of Neurology, Besançon University Hospital, Besançon, France
| | | | - Jennifer Dobson
- Department of Neurology, Besançon University Hospital, Besançon, France
| | - Jeanne-Antide Rouge
- Faculty of Medicine, University of Franche-Comté MedSim Laboratory, Besançon, France
| | - Thierry Moulin
- Department of Neurology, Besançon University Hospital, Besançon, France
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Choo ZY, Lenti G, Castaneda J, Hart C, Young S, Alcocer Alkureishi L. Effects of Telemedicine on Pediatric Clinical Care During COVID-19. Pediatr Ann 2021; 50:e503-e508. [PMID: 34889136 DOI: 10.3928/19382359-20211110-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has provided unprecedented opportunity for the growth of telemedicine in pediatrics. Clinics rapidly expanded their telemedicine capabilities and converted in-person visits to virtual visits to offer patients continued care while limiting infection risks. Although the transition to video visits has several benefits-patient convenience, versatility of care, ease of follow up, and management of chronic conditions-these gains are only available to those who have the requisite technology access and literacy needed to conduct a video visit. The need for technology-dependent care stands to further widen preexisting disparities in access to care for those who cannot use or afford the necessary technology. Our article explores some of these benefits and challenges and reminds us that although telemedicine has proven to have high utility for many patients, there are improvements that must still be made to ensure equitable accessibility and durability of virtual visits. [Pediatr Ann. 2021;50(12):e503-e508.].
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Drossman DA, Chang L, Deutsch JK, Ford AC, Halpert A, Kroenke K, Nurko S, Ruddy J, Snyder J, Sperber A. A Review of the Evidence and Recommendations on Communication Skills and the Patient-Provider Relationship: A Rome Foundation Working Team Report. Gastroenterology 2021; 161:1670-1688.e7. [PMID: 34331912 DOI: 10.1053/j.gastro.2021.07.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Over several decades, changes in health care have negatively impacted meaningful communication between the patient and provider and adversely affected their relationship. Under increasing time pressure, physicians rely more on technology than face-to-face time gathering data to make clinical decisions. As a result, they find it more challenging to understand the illness context and fully address patient needs. Patients experience dissatisfaction and a diminution of their role in the care process. For patients with disorders of gut-brain interaction, stigma leads to greater care dissatisfaction, as there is no apparent structural basis to legitimize the symptoms. Recent evidence suggests that practical communication skills can improve the patient-provider relationship (PPR) and clinical outcomes, but these data are limited. METHODS The Rome Foundation convened a multidisciplinary working team to review the scientific evidence with the following aims: a) to study the effect of communication skills on patient satisfaction and outcomes by performing an evidence-based review; b) to characterize the influence of sociocultural factors, health care system constraints, patient perspective, and telehealth on the PPR; c) to review the measurement and impact of communication skills training on these outcomes; and d) to make recommendations to improve communication skills training and the PPR. RESULTS Evidence supports the fact that interventions targeting patient-provider interactions improve population health, patient and provider experience, and costs. Communication skills training leads to improved patient satisfaction and outcomes. The following are relevant factors to consider in establishing an effective PPR: addressing health care system constraints; incorporating sociocultural factors and the role of gender, age, and chronic illness; and considering the changing role of telehealth on the PPR. CONCLUSIONS We concluded that effective communication skills can improve the PPR and health outcomes. This is an achievable goal through training and system change. More research is needed to confirm these findings.
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Affiliation(s)
- Douglas A Drossman
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, and the Rome Foundation, Chapel Hill, North Carolina.
| | - Lin Chang
- Vatche and Tamar Manoukian Division of Digestive Diseases, G. Opopenbhemer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, Calfornia
| | - Jill K Deutsch
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Alexander C Ford
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK
| | - Albena Halpert
- Gastroenterology,Harvard University Health Services, Boston, Massachusetts
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts
| | - Johannah Ruddy
- Center for Education and Practice of Biopsychosocial Care and Rome Foundation, Raleigh, North Carolina
| | - Julie Snyder
- Gastrointetinal Psychology Service, Boston University, Harvard Medical School, Boston, Massachusetts
| | - Ami Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Tanouye R, Nghiem J, Cohan K, Torres-Lavoro J, Schullstrom K, Mulcare M, Sharma R. Virtual Clinical Shadowing for Pre-Clinical Medical Students in an Emergency Medicine-Based Leadership Course. TELEMEDICINE REPORTS 2021; 2:233-238. [PMID: 35720750 PMCID: PMC9049813 DOI: 10.1089/tmr.2021.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 06/10/2023]
Abstract
Purpose: The COVID-19 pandemic limited pre-clinical medical students from participating in traditional clinical in-person shadowing. Rather than eliminating clinical shadowing from an established leadership course, we describe the experience of six pre-clinical medical students shadowing physician preceptors remotely through virtual platforms. Methods: Six pre-clinical medical students enrolled in 2020's Weill Cornell Medicine's Healthcare Leadership and Management Scholars Program were prepared with training materials for on-camera patient care. Students shadowed emergency medicine (EM) physicians providing clinical care in one of our New York Presbyterian emergency departments (EDs) and through telemedicine. Pre- and postsurveys were provided to these students. Results: From three different U.S. time zones, students were safely able to shadow EM physicians. The educational fidelity was maintained in physician-student relationships, but revealed opportunities for improvement in students' clinical learning, in ED clinical care, and in telemedicine visits. Conclusions: Virtual clinical shadowing is a viable option for pre-clinical students, when in-person options are not available. With logistical adjustments, this medium may be a long-term educational option especially for telemedicine.
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Affiliation(s)
- Robert Tanouye
- Department of Emergency Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York City, New York, USA
| | - Jodie Nghiem
- Department of Emergency Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York City, New York, USA
| | - Kaela Cohan
- Department of Emergency Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York City, New York, USA
| | - Jane Torres-Lavoro
- Department of Emergency Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York City, New York, USA
| | - Kaitlin Schullstrom
- Department of Emergency Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York City, New York, USA
| | - Mary Mulcare
- Department of Emergency Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York City, New York, USA
| | - Rahul Sharma
- Department of Emergency Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York City, New York, USA
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Cornes S, Gelfand JM, Calton B. Foundational Telemedicine Workshop for First-Year Medical Students Developed During a Pandemic. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11171. [PMID: 34337148 PMCID: PMC8282677 DOI: 10.15766/mep_2374-8265.11171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In response to the COVID-19 pandemic and the need for social distancing, medical education curricula across the country had to be quickly transitioned from in-person experiences to remote sessions. Simultaneously, use of telemedicine in clinical practice skyrocketed. Despite telemedicine expansion and the opportunity afforded to teach these skills virtually, many institutions lacked telemedicine curricula. METHODS We developed and evaluated a foundational telemedicine workshop during a pandemic (158 students in 28 groups) guided by principles to maximize learner engagement during remote learning, including use of discrete, time-limited activities (self-assessment, templated group exercises, review of brief multimedia, and active role-play.). RESULTS Students completed pre- and postsession surveys to assess session impact. Of 158 students, 92 (58%) completed the presession survey, and 36 (23%) completed the postsession survey. There was an increase in confidence in all areas, particularly in skills related to starting the encounter, minimizing barriers, and taking the medical history. Learners reported the physical examination content as more useful than any other area and valued the exemplar videos provided. DISCUSSION The pandemic highlighted our own institution's need to develop telemedicine curricula to prepare medical students to provide this increasingly essential service. We developed a foundational telemedicine skills session that increased students' reported confidence in their telemedicine knowledge and skills. The session could be easily adapted by other schools interested in incorporating telemedicine into their preclerkship curriculum. Additional experiences providing opportunities to practice and receive feedback on telemedicine skills with standardized and real patients are warranted.
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Affiliation(s)
- Susannah Cornes
- Associate Professor, Department of Neurology, University of California, San Francisco, School of Medicine
| | - Jeffrey M. Gelfand
- Associate Professor, Department of Neurology, University of California, San Francisco, School of Medicine
| | - Brook Calton
- Associate Professor, Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, School of Medicine
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