Hilty Donald, Chan Steven, Torous John, Luo John, Boland Robert
VA Northern California Health Care System, Mental Health & Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Mather, CA, United States.
Palo Alto VA Health Care System, Palo Alto, CA, United States.
JMIR Mhealth Uhealth. 2020 Feb 21;8(2):e12229. doi: 10.2196/12229.
To ensure quality care, clinicians need skills, knowledge, and attitudes related to technology that can be measured.
This paper sought out competencies for mobile technologies and/or an approach to define them.
A scoping review was conducted to answer the following research question, "What skills are needed for clinicians and trainees to provide quality care via mHealth, have they been published, and how can they be made measurable and reproducible to teach and assess them?" The review was conducted in accordance with the 6-stage scoping review process starting with a keyword search in PubMed/Medical Literature Analysis and Retrieval System Online, APA PsycNET, Cochrane, EMBASE, PsycINFO, Web of Science, and Scopus. The literature search focused on keywords in 4 concept areas: (1) competencies, (2) mobile technologies, (3) telemedicine mode, and (4) health. Moreover, 2 authors independently, in parallel, screened the search results for potentially relevant studies based on titles and abstracts. The authors reviewed the full-text articles for final inclusion based on inclusion/exclusion criteria. Inclusion criteria were keywords used from concept area 1 (competencies) and 2 (mobile technologies) and either 3 (telemedicine mode) or 4 (health). Exclusion criteria included, but were not limited to, keywords used from a concept area in isolation, discussion of skills abstractly, outline or listing of what clinicians need without detail, and listing immeasurable behaviors.
From a total of 1232 results, the authors found 78 papers eligible for a full-text review and found 14 papers directly relevant to the 4 key concepts. Although few studies specifically discussed skills, the majority were clinical studies, and the literature included no lists of measurable behaviors or competency sets for mobile technology. Therefore, a framework for mobile technology competencies was built according to the review, expert consensus, and recommendations of the Institute of Medicine's Health Professions Education Summit and Accreditation Council of Graduate Medical Education framework. This framework borrows from existing competency framework domains in telepsychiatry and social media (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication) and added domains of mHealth clinical decision support, device/technology assessment/selection, and information flow management across an electronic health record platform. mHealth Asynchronous components require additional traditional learning, teaching, supervisory and evaluation practices. Interactive curricula with case-, problem-, and system-based teaching may help faculty focus on decision making and shape skills and attitudes to complement clinical exposure.
Research is needed on how to customize implementation and evaluation of mHealth competencies and to ensure skill development is linked to the quality of care. This will require the management of organizational change with technology and the creation of a positive electronic culture in a complex policy and regulatory environment.
为确保优质医疗服务，临床医生需要具备与技术相关的可测量的技能、知识和态度。
本文旨在探寻移动技术的能力要求和/或定义这些能力要求的方法。
进行了一项范围综述，以回答以下研究问题：“临床医生和实习生通过移动医疗提供优质医疗服务需要哪些技能，这些技能是否已发表，如何使其可测量和可重复以用于教学和评估？”该综述按照6个阶段的范围综述流程进行，首先在PubMed/医学文献分析与联机检索系统、美国心理学会心理学文摘数据库、考克兰图书馆、荷兰医学文摘数据库、心理学文摘数据库、科学引文索引和Scopus中进行关键词搜索。文献搜索集中在4个概念领域的关键词：（1）能力要求；（2）移动技术；（3）远程医疗模式；（4）健康。此外，两名作者独立并行地根据标题和摘要筛选搜索结果，以查找潜在相关研究。作者根据纳入/排除标准对全文进行审查以确定最终纳入的文献。纳入标准是使用来自概念领域1（能力要求）和2（移动技术）以及3（远程医疗模式）或4（健康）的关键词。排除标准包括但不限于孤立使用一个概念领域的关键词、抽象讨论技能、仅列出临床医生所需内容而无详细说明以及列出不可测量的行为。
在总共1232条结果中，作者发现78篇论文符合全文审查要求，其中14篇与4个关键概念直接相关。虽然很少有研究专门讨论技能，但大多数是临床研究，文献中没有移动技术的可测量行为或能力要求集列表。因此，根据该综述、专家共识以及医学研究所卫生职业教育峰会和毕业后医学教育认证委员会框架的建议，构建了移动技术能力要求框架。该框架借鉴了远程精神病学和社交媒体现有的能力要求框架领域（患者护理、医学知识、基于实践的学习与改进、基于系统的实践、专业精神以及人际技能与沟通），并增加了移动医疗临床决策支持、设备/技术评估/选择以及跨电子健康记录平台的信息流管理领域。移动医疗异步组件需要额外的传统学习、教学、监督和评估实践。采用基于案例、问题和系统的教学的交互式课程可能有助于教师专注于决策制定，并塑造技能和态度以补充临床实践经验。
需要开展关于如何定制移动医疗能力要求的实施和评估，以及确保技能发展与医疗服务质量挂钩的研究。这将需要在复杂的政策和监管环境中通过技术管理组织变革并营造积极的电子文化。
