Telemedicine Curriculum Research Articles

Teaching and Evaluating the Virtual Physical Exam in Telemedicine.

With the rapid adoption of telemedicine since the COVID-19 pandemic, it has become imperative to teach and evaluate health professional trainees on skills important to conducting effective virtual visits. We developed a simulation-based workshop with (1) readings, (2) a lecture covering online communication and the virtual head and neck exam, (3) a telemedicine simulation with a standardized patient observed by faculty, (4) personalized feedback from faculty, and (5) a group debrief session. We created an evaluation rubric based on three of 20 Association of American Medical Colleges (AAMC) telemedicine competencies to assess learner performance during the simulations. Students (medical and physician assistant students; n = 50), and internal medicine residents (n = 20) completed this workshop in 2023. At least 90% of trainees across the two groups were rated as approaching entrustment or entrustable in each competency. This workshop is an example of a scalable telemedicine curriculum that can be used to teach and evaluate learners in the virtual physical exam across the training continuum.

Experiences of Residents and Fellows at Mayo Clinic After the Rapid Implementation of Telemedicine During the COVID-19 Pandemic.

The COVID-19 pandemic led to many changes across medical organizations and graduate medical education programs nationwide including the rapid implementation of telemedicine as a modality for delivering health care. The purpose of this study was to investigate the telemedicine experiences of residents and fellows with their self-reported level of preparedness, impact on their education including precepting, skill development, and patient-physician relationships, and perceptions of telehealth platforms and curricula in the future. A total of 365 Mayo Clinic residents and fellows across three sites (Florida, Arizona, and Minnesota) were identified as trainees who conducted at least one telemedicine encounter from January 1, 2020 to June 30, 2020 and were sent an electronic survey by e-mail. There was a total of 103 completed surveys across various specialties with 58.3% female respondents, 63.1% residents, 35.0% fellows and 77.7% of respondents who attended medical school in the United States. Most trainees reported having very little to no exposure to telemedicine in their medical careers before the pandemic. The majority were satisfied with their first telemedicine encounter and found precepting comparable to in-person visits. The trainees in this study had a favorable view with 98.1% believing telemedicine will play a more prevalent role in the future and most agreed this should be included in medical school and residency training. Our survey found that after the implementation of telemedicine during the COVID-19 pandemic, the experiences of trainees at a multi-site academic center were overall positive. More research is needed on the perceptions of skill development (physical exam and history taking) during a telemedicine encounter and outlining an optimal telemedicine curriculum that can improve confidence in trainees.

The COVID-19 pandemic's impact on sleep medicine fellowship telemedicine training: a follow-up survey of program directors.

Our 2019 survey of sleep medicine fellowship program directors (PDs) indicated that fellows' contact with telemedicine was limited. Within months, the coronavirus disease 2019 (COVID-19) pandemic significantly impacted the field. This survey describes fellows' telemedicine exposure, their PDs' attitudes toward it, and their formalized telemedicine training during the pandemic's third year. A 33-item SurveyMonkey questionnaire was developed. Many quantitative (Likert scale) items were identical to items on the 2019 survey for direct comparison. An open-ended question was added for qualitative analyses. All 91 sleep medicine fellowship PDs were invited to participate. The SurveyMonkey platform provided quantitative item descriptive statistics. Qualitative data underwent thematic analyses using codebook methodology. Forty (97.5%) PDs indicated their program offers a telemedicine experience. Thirty-two (80%) PDs observed at least a 10% increase in sleep fellows' telemedicine encounters compared with prepandemic times. Although 27 (67.5%) PDs agreed that a national telemedicine curriculum could be useful, 8 (20%) of them offer a sleep telemedicine curriculum. Qualitative feedback revealed diverging attitudes toward telemedicine's place in sleep medicine practice, fellowship training, and the utility of a national curriculum. Sleep telemedicine utilization during fellowship training was markedly higher on this 2022 survey (97.5%) compared with a similar 2019 survey (33.3%), and most PDs agreed a standardized curriculum could be useful. However, relatively few programs offer formalized telemedicine training. These findings imply that, while most sleep medicine fellows participate in telemedicine, they lack the formalized training that may optimize their utilization of the medium in their postfellowship careers. Fields BG, Kaur K, Dholakia S, Ioachimescu O. The COVID-19 pandemic's impact on sleep medicine fellowship telemedicine training: a follow-up survey of program directors. J Clin Sleep Med. 2024;20(2):201-210.

Telemedicine Competencies in Family Medicine Clerkships: A CERA Study.

While the Association of American Medical Colleges (AAMC) designated cross-disciplinary telemedicine competencies, curricular implementation is at disparate stages across medical schools and with significant curricular gaps. We investigated factors associated with the presence of telemedicine curriculum in family medicine clerkships. Data were evaluated as part of the 2022 CERA survey of family medicine clerkship directors (CD). Participants answered questions about telemedicine curriculum in their clerkship, including whether it was required or optional, whether telemedicine competencies were assessed, the availability of faculty expertise, volume of visits, student autonomy in visits, CD's attitude about the importance of telemedicine education, and awareness of the Society of Teachers of Family Medicine's (STFM) Telemedicine Curriculum. Ninety-four of 159 CDs (59.1%) responded to the survey. Over one-third of FM clerkships (38, 41.3%) did not teach telemedicine and most CDs (59, 62.8%) did not assess competencies. The presence of telemedicine curriculum was positively associated with CDs' awareness of STFM's Telemedicine Curriculum (P=.032), attitude of CDs toward importance of telemedicine teaching (P=.007), higher level of learner autonomy in telemedicine visits (P=.035), and private medical schools (P=.020). Almost two-thirds of clerkships (62.8%) did not assess telemedicine competencies, and fewer than one-third of CDs (28.6%) considered telemedicine education as important as other clerkship topics. CDs' attitudes were a significant determinant of whether teaching of telemedicine skills occurred. Awareness of telemedicine education resources and higher learner autonomy in telemedicine encounters may promote integration into clerkship curriculum.

Improvement of Medical Student Performance in Telemedicine Standardized Patient Encounters Following an Educational Intervention.

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. 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. 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). 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.

Telemedicine Management of COPD: Advancements in Chronic Disease Treatment and Implications for Medical Education

Social determinants of health are non-medical, social and economic factors that influence health. The practice of telemedicine enables physicians to virtually connect patients with healthcare resources. Throughout the COVID-19 pandemic, healthcare providers have increasingly utilized telemedicine as a method to provide appropriate care to patients with chronic diseases, including Chronic Obstructive Pulmonary Disease (COPD). COPD is a progressive obstructive lung disorder which is substantially impacted by social determinants of health including access to healthcare. The successful utilization of telemedicine in the care of patients with chronic diseases, including COPD, highlights its emerging importance in healthcare. However, many Canadian medical schools have yet to implement a formalized telemedicine curriculum, and most Canadian students do not feel adequately prepared for virtual healthcare delivery. Here, we outline the utilization of telemedicine in COPD management and advocate for the rapid introduction of a formalized telemedicine curriculum at the undergraduate and postgraduate levels.

Feasibility and Acceptability of a US National Telemedicine Curriculum for Medical Students and Residents: Multi-institutional Cross-sectional Study

Telemedicine use increased as a response to health care delivery changes necessitated by the COVID-19 pandemic. However, lack of standardized curricular content creates gaps and inconsistencies in effectively integrating telemedicine training at both the undergraduate medical education and graduate medical education levels. This study evaluated the feasibility and acceptability of a web-based national telemedicine curriculum developed by the Society of Teachers of Family Medicine for medical students and family medicine (FM) residents. Based on the Association of American Medical Colleges telehealth competencies, the asynchronous curriculum featured 5 self-paced modules; covered topics include evidence-based telehealth uses, best practices in communication and remote physical examinations, technology requirements and documentation, access and equity in telehealth delivery, and the promise and potential perils of emerging technologies. A total of 17 medical schools and 17 FM residency programs implemented the curriculum between September 1 and December 31, 2021. Participating sites represented 25 states in all 4 US census regions with balanced urban, suburban, and rural settings. A total of 1203 learners, including 844 (70%) medical students and 359 (30%) FM residents, participated. Outcomes were measured through self-reported 5-point Likert scale responses. A total of 92% (1101/1203) of learners completed the entire curriculum. Across the modules, 78% (SD 3%) of participants agreed or strongly agreed that they gained new knowledge, skills, or attitudes that will help them in their training or career; 87% (SD 4%) reported that the information presented was at the right level for them; 80% (SD 2%) reported that the structure of the modules was effective; and 78% (SD 3%) agreed or strongly agreed that they were satisfied. Overall experience using the national telemedicine curriculum did not differ significantly between medical students and FM residents on binary analysis. No consistent statistically significant relationships were found between participants' responses and their institution's geographic region, setting, or previous experience with a telemedicine curriculum. Both undergraduate medical education and graduate medical education learners, represented by diverse geographic regions and institutions, indicated that the curriculum was broadly acceptable and effective.

Telemedicine in Anesthesiology: Using Simulation to Teach Remote Preoperative Assessment.

The move toward telemedicine has markedly accelerated with the COVID-19 pandemic. Anesthesia residents must learn to provide preoperative assessments on a virtual platform. We created a pilot telemedicine curriculum for postgraduate year-2 (PGY2) anesthesiology. The curriculum included a virtual didactic session and a simulated virtual preoperative assessment with a standardized patient (SP). A faculty member and the SP provided feedback using a checklist based on the American Medical Association Telehealth Visit Etiquette Checklist and the American Board of Anesthesiology Applied Examination Objective Structured Clinical Examination content outline. Residents completed surveys assessing their perceptions of the effectiveness and helpfulness of the didactic session and simulated encounter, as well as the cognitive workload of the encounter. A total of 12 PGY2 anesthesiology residents in their first month of clinical anesthesia residency training participated in this study. Whereas most (11/12) residents felt confident, very confident, or extremely confident in being able to conduct a telemedicine preoperative assessment after the didactic session, only 42% ensured adequate lighting and only 33% ensured patient privacy before conducting the visit. Postencounter survey comments indicated that the SP encounter was of greater value (more effective and helpful) than the didactic session. Residents perceived the encounter as demanding, but they felt successful in accomplishing it and did not feel rushed. Faculty and SP indicated that the checklist guided them in providing clear and useful formative feedback. A virtual SP encounter can augment didactics to help residents learn and practice essential telemedicine skills for virtual preoperative assessments.

Use of Telemedicine in the Family Medicine Clerkship: A CERA Study.

In March 2020 with the onset of the COVID-19 pandemic, clinical rotations abruptly ceased, and telemedicine became an alternative to in-person patient care. This study investigates factors associated with long-term adoption of telemedicine during family medicine clerkships. Data were gathered from the 2021 CERA survey of family medicine clerkship directors. Participants answered questions about the use of telemedicine in the clerkship, adequacy of telemedicine resources, how well telemedicine visits helped students meet course objectives, quality of course evaluations, efficiency of students seeing patients using telemedicine, and likelihood of continuing use of telemedicine once in-person visits are reinstated. The response rate was 48.8%. While most clerkship directors did not use telemedicine prior to the COVID-19 pandemic with their own patients, most had medical students utilize telemedicine during the pandemic. Clerkship directors were more likely to continue having students use telemedicine in the clerkship if it helped them meet clerkship objectives, if telemedicine visits were efficient, and if course evaluations were positive. Adequacy of resources was not associated with likelihood of retaining telemedicine in the clerkship. Family medicine clerkship directors will likely continue to have students see patients via telemedicine, particularly if feedback is positive. Family medicine educators need to develop and evaluate new telemedicine curriculum for learner benefit, patient acceptability, and overall care quality.

Telemedicine in Pediatric Training: A National Needs Assessment of the Current State of Telemedicine Education in Pediatric Training.

To describe the current state of telemedicine within pediatric training programs to inform development of a national telemedicine training curriculum for pediatric trainees. We conducted an anonymous cross-sectional survey of pediatric residency (Fall 2020) and fellowship program directors (Spring 2021) on their current telemedicine practices in pediatric post-graduate training. Forty-eight US pediatric residency programs (n=48/198, 24%) and 422 fellowship programs completed the survey (n=422/872, 48%); combined response rate 44% (n=470/1070). Pre-COVID-19, 12% (n=57/470) of programs surveyed reported using telemedicine in their training program, but during the pandemic 71% (n=334/470) reported telemedicine use with trainees. Over 71% (n=334/470) agreed that a formalized curriculum is important, yet 69% (n=262/380) of programs reporting telemedicine use either did not have a curriculum or were unsure if one existed at their program. Respondents who were unsure/not likely to add a telemedicine curriculum and/or indicated that a telemedicine curriculum would not be important (52% n=243/470), cited "time" (55%, n=136/243) most frequently as a barrier. Our needs assessment indicates marked increase in use of telemedicine with trainees by respondent pediatric training programs, with fewer than 50% reporting a formalized training curriculum and most agreeing that a curriculum is important.

Correction

The Stanford Department of Emergency Medicine joined forces with Digital Medic to create educational materials to teach global healthcare providers how to evaluate patients via telemedicine in the setting of COVID-19. Users then asked for additional education on best practices surrounding the use of telemedicine as a communication medium. Here, we describe our experience in the creation of this additional module and provide some basic feedback received from end-users. We scripted, filmed, and edited a video module for this application over the course of 14 weeks. It was subsequently deployed as part of the larger COVID-19 educational program. To date, the course has had over 28,000 participants. Each was asked to take a pre- and post-test to assess the knowledge of telemedicine best practices before and after the video module; 19,412 elected to take the pre-test and 19,364 took the post-test with overall scores of 84% and 95%, respectively. Anecdotal feedback has been positive. Telemedicine systems have proliferated rapidly around the world, but best practices for physician-to-patient interactions have not been similarly disseminated. We conclude that video modules can be used to fill this educational need quickly and economically.

Enhancing Virtual Communication Skills Among Medical Learners: A COVID-19 Telemedicine Goals of Care Standardized Encounter (QI430)

Outcomes1. Evaluate the effectiveness of a virtual communication framework to conduct goals-of-care conversations2. Emphasize the importance of adapting a complex communication curriculum to current telemedicine needsBackgroundThe COVID-19 pandemic has forced adaptations in medicine, causing rapid growth in the use of telemedicine to continue caring for patients. Although undergraduate medical education has also been forced to adapt curriculum to a distance learning or virtual model, many providers have no formal telemedicine or COVID-19-specific goals-of-care (GOC) training. Thus, a COVID-19 GOC telemedicine curriculum was developed to provide undergraduate medical learners (UMLs) the skills necessary to facilitate advance care planning (ACP) via a virtual platform.Aim StatementDevelop an effective COVID-19 GOC telemedicine curriculum.MethodsUMLs were given a 2-hour virtual training session using P-T-SPIKEES, a framework for conducting difficult discussions with patients via telemedicine. Training objectives included gaining an understanding of telemedicine, ACP, and risk factors for worsening COVID-19 disease to facilitate appropriate COVID-19 GOC conversations. UMLs underwent pre/post training surveys in addition to a GOC Telemedicine Objective Structured Clinical Examination (TeleOSCE). Learner pre/post training survey responses were compared to their GOC TeleOSCE performance evaluation to gauge effectiveness of this pilot program.ResultsN = 83 UMLs. UMLs who experienced systemic technical problems or had incomplete data lacking either a pre, post, or TeleOSCE evaluation survey were excluded from the study. 10% of UMLs had prior telemedicine training, 50% had prior GOC training, and 0% had previously participated in a TeleOSCE. After completing the curriculum, 68% received scores of excellent or above average on their TeleOSCE performance. UML self-evaluated GOC competency increased from 33% to 89%, a 2.7-fold increase, and TeleOSCE competency increased from 22% to 90%, a 4-fold increase.Conclusions and ImplicationsA COVID-19 GOC telemedicine curriculum using the P-T-SPIKEES framework can effectively teach UMLs the skills necessary to facilitate COVID-19-focused GOC discussions via a virtual platform. Further studies should examine the use of the P-T-SPIKEES framework throughout different institutions and in graduate medical education.

Developing Telemedicine Curriculum Competencies for Graduate Medical Education: Outcomes of a Modified Delphi Process.

Telemedical applications have only recently begun to coalesce into the field of telemedicine due to varying definitions of telemedicine and issues around reimbursement. This process has been accelerated by the COVID-19 pandemic and the ensuing expansion of telemedicine delivery. This article demonstrates the development of a set of proposed competencies for a telemedicine curriculum in graduate medical education. A modified Delphi process was used to create a panel of competencies. This included a systematic review of the telemedicine literature through November 2019 to create an initial set of competencies, which were analyzed and edited by a focus group of experts in January 2020. Initial competencies were distributed in a series of 3 rounds of surveys to a group of 23 experts for comments and rating from April to August 2020. Competencies that obtained a score of 4.0 or greater on a 5-point Likert scale in at least 2 rounds were recommended. Fifty-five competencies were developed based on the systematic review. A further 32 were added by the expert group for a total of 87. After 3 rounds of surveys, 34 competencies reached the recommendation threshold. These were 10 systems-based practice competencies, 7 professionalism, 6 patient care, 4 practice-based learning and improvement, 4 interpersonal and communication skills, and 3 medical knowledge competencies. Half (17/34) of the competencies approved by the focus group and surveyed expert panel pertained to either systems-based practice or professionalism. Both categories exhibit more variation between telemedicine and in-person practice than other categories. The authors offer a set of proposed educational competencies that can be used in the development of curricula for a wide range of providers and are based on the best evidence and expert opinion available.

Cultivating "Webside Manner" at the UME-GME Transition Point During the COVID-19 Pandemic: A Novel Virtual Telemedicine Curriculum.

BACKGROUNDTelemedicine use in the US has continued to grow over the past few years with the development of new technology and in response to the COVID-19 pandemic. This has led to a growing need for formal training in telemedicine for clinicians in order to improve communication skills and provide better patient outcomes.METHODSA self-directed, five-unit online curriculum focused on telemedicine essentials was developed through discussions among Pediatric clinical educators and adapted from literature in telemedicine education. Improvement of communication skills was determined through evaluations of interns randomly assigned to either the telemedicine curriculum or the control group, which was then compared to their baseline encounters.RESULTSInterns who completed the telemedicine curriculum showed significant improvement in communication scores compared to those who did not complete the curriculum.CONCLUSIONResults from the study show the effectiveness of a formal telemedicine curriculum in improving critical communication skills for application in telemedicine.

A Comparison of Family Medicine Resident Documentation Following Implementation of an Asynchronous vs Synchronous Telemedicine Curriculum.

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. 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. 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. 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.

Telemedicine Curriculum in an Ophthalmology Residency Program

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.

Teaching From Afar: Development of a Telemedicine Curriculum for Healthcare Workers in Global Settings.

The Stanford Department of Emergency Medicine joined forces with Digital Medic to create educational materials to teach global healthcare providers how to evaluate patients via telemedicine in the setting of COVID-19. Users then asked for additional education on best practices surrounding the use of telemedicine as a communication medium. Here, we describe our experience in the creation of this additional module and provide some basic feedback received from end-users. We scripted, filmed, and edited a video module for this application over the course of 14 weeks. It was subsequently deployed as part of the larger COVID-19 educational program. To date, the course has had over 28,000 participants. Each was asked to take a pre- and post-test to assess the knowledge of telemedicine best practices before and after the video module; 19,412 elected to take the pre-test and 19,364 took the post-test with overall scores of 84% and 95%, respectively. Anecdotal feedback has been positive. Telemedicine systems have proliferated rapidly around the world, but best practices for physician-to-patient interactions have not been similarly disseminated. We conclude that video modules can be used to fill this educational need quickly and economically.

188 Implementation of a Telemedicine Student Clinic

As part of a curricular change, an academic medical center implemented a medical student telemedicine education clinic for first-year medical students in October 2020. By augmenting current AAMC and LCME compliant educational standards with a telemedicine clinic experience, preclinical medical students learned versatile patient-care skills that will be effective in both in-person and virtual clinic settings. This research describes the initial successes and challenges of implementing a pre-clerkship medical student telemedicine education clinic. This research is a process evaluation of the implementation of a pre-clerkship medical student telemedicine education clinic. Patients with two or more chronic diseases were recruited from affiliated primary care practices. Students worked in pairs to perform each of the curricular goals and objectives including: reviewing the patient’s electronic medical record (EMR) and care plan, interviewing patients via a telemedicine platform, and documenting patient interactions (including an assessment and plan) in the EMR. These patient encounters were not directly supervised by faculty. Immediately after the visit, students gave an oral presentation to on-site faculty, and provided a written note to the on-site faculty and the patient’s primary care physician. If a patient visit could not be completed, a standardized patient was utilized for the telemedicine visit. In order to evaluate the program, the following data were collected: number of patient contacts, visit outcomes (including completion/non-completion of the visit, successful/unsuccessful telemedicine utilization, adequacy or need for other types of connection, need/no need for intervention by the on-site faculty for an emergent or urgent medical issue), student surveys, and patient surveys. A total of 382 patients were contacted and 122 agreed to participate in a visit (32%). Since program initiation, 15 patients have been removed by their request or for more than two visit cancellations (13.4%), and two due to death (1.6%). In the first seven months of the clinic, students scheduled 573 visits of which 373 (65%) were successfully completed. The other 200 visits (35%) were cancelled by the patient or the patient did not connect for the visit. On-site faculty intervened in 14.3% of encounters for the following reasons: send to the emergency department 1.3%, urgent consult for specialty care 5%, 24-hour follow up with PCP 8%. Visit lengths varied as follows: 0-10 minutes 6.2%, 10-20 minutes 65%, 20-30 minutes 23.2%, >30 minutes 5.6%. Patient surveys demonstrate that 67.9% felt the student clinic would enhance communication with their primary care physician “a lot” to “a great deal.” Patients rated the student as “somewhat” to “extremely professional” for 87.5% of the visits. Students evaluated the experience as follows: Excellent 71%, Good 26%, Average 3%, Poor 0%. Student skill completion is listed in Table 1. This research demonstrates that the implementation of a preclinical telemedicine curriculum is possible (patients are willing to participate), provides an opportunity for skill development, and was viewed favorably by both patients and students. Preliminary data on patient retention and student satisfaction suggest that this is a sustainable model for developing telemedicine competencies in preclinical medical students.

FAMILY MEDICINE DEPARTMENTS AND PROGRAMS TO PILOT STFM TELEMEDICINE CURRICULUM

The Society of Teachers of Family Medicine (STFM) is piloting a telemedicine curriculum and conducting a national study to evaluate its effectiveness. The American Academy of Family Physicians Institutional Review Board has reviewed and approved this study. The curriculum includes 5 asynchronous

Preparing Future Doctors for Telemedicine: An Asynchronous Curriculum for Medical Students Implemented During the COVID-19 Pandemic.

The COVID-19 pandemic led to changes in both the clinical environment and medical education. The abrupt shift to telemedicine in March 2020, coupled with the recommendation that medical students pause in-person clinical rotations, highlighted the need for student training in telemedicine. To maintain students' ability to participate in clinical encounters and continue learning in the new virtual environment, a telemedicine curriculum for clinical students was rapidly developed at Harvard Medical School (HMS) focusing on the knowledge and skills needed to conduct live video encounters. Curriculum leads created an interactive, flexible curriculum to teach students clinical skills, regulatory issues, professionalism, and innovations in telemedicine. This 5-module curriculum was delivered using various primarily asynchronous modalities including webinar-style presentations, prerecorded videos of physical exams from different disciplines, shadowing a synchronous telemedicine visit, peer discussions in small groups, and quizzes with both multiple-choice and open-ended questions. During May 2020, 252 clerkship and postclerkship medical students at HMS completed the telemedicine curriculum. All students completed a precourse survey and 216 (85.7%) completed the postcourse survey. Students' self-rated knowledge of telemedicine increased, on average, from 38 (15.1%) reporting being fairly/very knowledgeable over 4 domains before the course to 182 (84.3%) afterward (P < .001). The course was highly rated, with 176/205 (85.9%) students reporting that it met their learning needs and 167/205 (81.5%) finding the delivery methods to be effective. Of 101 (45.3%) students who answered an open-ended postcourse survey question, 91 (90.1%) reported asynchronous learning to be a positive experience. As telemedicine becomes increasingly and likely permanently integrated into the health care system, providing medical students with robust training in conducting care virtually will be essential. This curriculum provides a promising and feasible framework upon which other schools can apply these emerging competencies to design their own telemedicine curricula.