Telehealth Curriculum Research Articles

Curricular response to COVID-19: real-time interactive telehealth experience (RITE) program

ABSTRACT Introduction. The COVID-19 pandemic placed an unprecedented strain on academic healthcare systems necessitating a pause in medical student teaching in clinical care settings, including at Weill Cornell Medicine (WCM). WCM had a preexisting telemedicine curriculum, but limited opportunities for students to apply knowledge and skills related to direct virtual patient care. The authors describe the rapid implementation of real-time interactive telehealth experience (RITE) courses for clerkship students to allow for meaningful engagement in remote patient care and continuation of academic progress during the pause. Methods of Course Development. Medical school administration disseminated a request for proposals for RITE courses conforming to the WCM electives format with rapid turnaround time of 1 week or less. Requirements included remote care activities, goals and objectives, general logistics, supervision methods and standards of achievement. RITE courses were developed in outpatient medicine, inpatient medicine, psychiatry and women’s health. A lottery process was developed to register students for the approved courses. Course Implementation and Evaluation. Using the technical platform and standard course registration process, students were assigned to 74 of 76 available RITE course slots. Students participated in supervised remote direct patient care and also provided critical support for frontline healthcare workers by performing remote clinical tasks. Online teaching and reflection sessions were incorporated into each RITE curricular offering. Student feedback was overall positive ranging from 3.33–4.57 out of 5. Discussion. The COVID-19 pandemic created a need to rapidly incorporate telehealth models in order to continue to deliver patient care and an opportunity to develop innovative remote educational experiences. We developed a framework for structured real-time interactive telehealth experiences to address COVID-19 related curricular needs that will be continued post-COVID-19. This expanded telehealth curriculum for our students will provide standardized training in telehealth logistics, communication techniques, and care delivery now essential for graduating medical students.

A Geriatrics Telehealth Curriculum: A Workshop for Medical Students on “Tele-skills” using Standardized Patients

Background: Telemedicine allows for interprofessional care of geriatric patients and allows older adults to access healthcare from their homes. The coronavirus pandemic has prompted a rapid shift to telemedicine. In 2016-2017, only 58% of medical schools in the US offered telemedicine curricula. Thus, a large gap in medical education has emerged. There are specific skills needed to ensure students’ “webside” manner is comparable to their bedside manner.This curriculum was created to train medical students in geriatric-sensitive telemedicine using standardized patients (SP). Methods: A didactic detailing geriatric interviewing preceded the SP encounter. Students were assigned roles for the SP encounter as follows: A) Set agenda, elicit questions, triage problems, perform a history, ensure appropriate lighting and audio B) Perform a geriatric review of systems and reconcile medications C) Present an assessment and plan to the preceptor D) Relay the plan to the SP E) Provide feedback. Students were given pre- and post-surveys to assess their comfort using telemedicine and caring for SP’s >65 years old. Results: Seventeen participants were surveyed (pre-survey=17, post-survey=10). Fifty-nine percent of participants reported no prior experience with telemedicine. Participants reported statistically significant increases in comfort using telemedicine (p=0.022), using telemedicine for patients >65 years old (p<0.001), interviewing patients >65 years old over telemedicine (p=0.007), managing patients over telemedicine (p=0.040), and managing patients >65 years old over telemedicine (p=0.001) after completing the curriculum. Discussion: This virtual curriculum improved medical student comfort with geriatric care and telemedicine and highlights the need for telemedicine curricula in medical schools.

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

Despite increasing use of telehealth, there are limited published curricula training primary care providers in utilizing telehealth to deliver complex interdisciplinary care. To describe and evaluate a telehealth curriculum with a longitudinal objective structured clinical examination (OSCE) to improve internal medicine residents' confidence and skills in coordinating complex interdisciplinary primary care via televisits, electronic consultation, and teleconferencing. In 2019, 56 first- and third-year residents participated in a 3-part, 5-week OSCE training them to use telehealth to manage complex primary care. Learners conducted a standardized patient (SP) televisit in session 1, coordinated care via inter-visit e-messaging, and led a simulated interdisciplinary teleconference in session 2. Surveys measured confidence before session 1 (pre), post-session 1 (post-1), and post-session 2 (post-2). SP televisit checklists and investigators' assessment of e-messages evaluated residents' telehealth skills. Response rates were pre 100%, post-1 95% (53 of 56), and post-2 100%. Post-intervention, more residents were "confident/very confident" in adjusting their camera (33%, 95% CI 20-45 vs 85%, 95% CI 75-95, P < .0001), e-messaging (pre 36%, 95% CI 24-49 vs post-2 80%, 95% CI 70-91, P < .0001), and coordinating interdisciplinary care (pre 35%, 95% CI 22-47 vs post-2 84%, 95% CI 74-94, P < .0001). More residents were "likely/very likely" to use telemedicine in the future (pre 56%, 95% CI 43-69, vs post-2 79%, 95% CI 68-89, P = .001). A longitudinal, interdisciplinary telehealth simulation is feasible and can improve residents' confidence in using telemedicine to provide complex patient care.

Assessment of a Pediatric Population Using Telehealth Training in Predoctoral Dental Education

This article aims to increase dental workforce and quantify outcomes of telehealth curriculum by integrating predoctoral dental students in the delivery of asynchronous teledentistry. Preliminary data from the quality improvement process suggests that over 90% of recommended treatment plans coincided between onpremise and off-premise, second-year predoctoral dental students. This initial data establishes a quantitative measurement for telehealth and supports the incorporation of teledentistry into predoctoral dental curriculum for its use in clinical practice.

Exploring telehealth in the graduate curriculum.

BackgroundWith an increase in patient demand and a decrease in healthcare professionals, telehealth is able to provide needed services to patients, but appropriate training in telehealth is crucial for providers to deliver excellent patient care.MethodNurse researchers developed a quality improvement project targeting telehealth in the graduate nursing curriculum. A two‐part evidence‐based curriculum was developed for graduate family nurse practitioner (FNP) students. Part one consisted of a lecture that focused on increasing students' knowledge, and part two enhanced skills through simulation.ResultsData were collected through qualitative and quantitative surveys. The qualitative data were analyzed for themes and statistical analysis of the quantitative data was completed (t‐scores and descriptive statistics). Results showed that FNP students perceived the telehealth curriculum as educational and recommend it be continued for future FNP cohorts.ConclusionUsing evidence‐based practice and telehealth experts graduate nursing programs should introduce the telehealth curriculum for FNP students through in class lecture and simulation.

University of Rochester School of Medicine and Dentistry

University of Rochester School of Medicine and Dentistry

Reinforcing Telehealth Competence Through Nurse Practitioner Student Clinical Experiences.

Telehealth is becoming increasingly integral in providing improved access to care, especially for patients who reside in frontier and rural areas. Nurse practitioner (NP) faculty are charged with preparing NP students through curriculum and clinical experiences that align with the health care environment and the health care access needs of the populations they serve. To meet this need, NP faculty at a land-grant university located in a frontier and rural midwestern state reinforced NP student telehealth curriculum and competency through application in a clinical environment. Participants included 22 family NP (FNP) students and 19 clinical preceptors. According to the evaluations, the FNP students met seven of the eight competency criteria, and the preceptors met eight of the 13 evaluation criteria. Outcomes indicate telehealth curriculum competency can be reinforced through application in a clinical setting to prepare NP students to meet the needs of patients and changing health care environments. [J Nurs Educ. 2020;59(7):413-417.].

Integration of Telehealth Education into the Health Care Provider Curriculum: A Review.

Introduction: Telehealth is a rapidly expanding health care delivery modality with increasing utility in the health care community. It is imperative that telehealth education is provided during the training of health care providers to ensure the proper usage and application of this health care delivery system. A comprehensive literature review of telehealth education integrated into the curricula of physician, physician assistant, and advanced practiced registered nurse training programs has not been reported to date. Materials and Methods: An electronic literature search was performed using Scopus®, PubMed, and 17 of the 35 databases on the EBSCOHost platform. We included studies where telehealth concepts and components were integrated in the curriculum for primary care students. We extracted information pertinent to understanding the scope and sustainability of the curriculum and tabulated the results. Results: After a full-text screening of 164 articles and critically analyzing 34, eight articles were included in this review. Comparison of these articles showed no consistency in how telehealth was integrated into the various health care curricula. Content delivered usually included basic telehealth information, however, the depth and breadth of content varied significantly based on the interventions. Discussion: For the articles included in this review, there were no formal study designs regarding basic telehealth educational integration or competencies. While authors recommended conducting evaluation and determining the effectiveness of the interventions, they did not provide a clear picture as to how these efforts should be conducted. Conclusions: In addition to developing a standardized telehealth curriculum, national competencies need to be created, which will guide the development of standardized curriculum across health care training programs.

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

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

An Interdisciplinary, Multi-Institution Telehealth Course for Third-Year Medical Students.

The American Medical Association has called for telehealth to become a core competency of medical students. Studies indicate that a principal reason physicians do not practice telehealth is lack of training, yet patient interest in and satisfaction with telehealth are high. No comprehensive U.S. undergraduate medical education curriculum teaching telehealth principles has been published. In February 2018, the Uniformed Services University of the Health Sciences (USU) provided an innovative telehealth training experience for third-year medical students. USU led an interinstitutional, interprofessional learner-centered course including six segments: (1) multiple-choice pretest; (2) asynchronous lectures covering telehealth history, applications, ethics, safety, military uses, etiquette, and patient considerations; (3) in-person interactive telehealth instruction including patient selection, current uses, and risk management; (4) faculty-supervised mock patient telehealth encounters; (5) hands-on diagnosis and advanced surgical procedures using telehealth equipment; and (6) multiple-choice posttest. This course was piloted with 149 third-year medical students. Students' improvement in telehealth knowledge was demonstrated through (1) 10.1% average improvement between pre- and posttest scores, (2) completion of competency-based checklists, and (3) postcourse preceptor and student feedback. Faculty feedback indicated that technology use was novel and effective based on student input. Faculty noted that students enjoyed engaging via videoconference. Of participating medical students, 119 (80%) indicated future plans to practice telehealth; several requested to be part of future telehealth courses. Telehealth will be integrated into clinical rotations in collaboration with other institutions. As the telehealth curriculum is taught at other institutions, lessons learned will inform enhancements at USU.