Zhu Xi, Merchant Kimberly A S, Mohr Nicholas M, Wittrock Amy J, Bell Amanda L, Ward Marcia M
Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
Telemed J E Health. 2021 Apr;27(4):441-447. doi: 10.1089/tmj.2020.0042. Epub 2020 Jun 17.
The low volume and the intermittent nature of serious emergencies presenting to rural emergency departments (EDs) make it difficult to plan and deliver pertinent professional training. Telemedicine provides multiple avenues for training rural ED clinicians. This study examines how telemedicine contributes to professional training in rural EDs through both structured and unstructured approaches. This qualitative study examined training experiences in 18 hospitals located in 6 Midwest states in the United States, which participated in a single hub-and-spoke telemedicine network. Twenty-eight interviews were conducted with 7 physicians, 10 advanced practice providers, and 11 nurses. Standard, inductive qualitative analysis was used to identify key themes related to experiences with telemedicine-based training and its impact on rural ED practice. For structured formal training, rural ED clinicians used asynchronous sessions more often than live sessions. It was reported that the formal training program may not have been fully utilized due to time and workload constraints. Rural clinicians strongly valued unstructured real-time training during telemedicine consultations. It was perceived consistently across professional groups that real-time training occurred frequently and its spontaneous nature was beneficial. Hub providers offering suggestions respectfully and explaining the rationale behind recommendations facilitated real-time learning. Rural providers and nurses perceived several effects of real-time training, including keeping rural practice up to date, instilling confidence, and improving performance. Our research shows that telemedicine provided rural ED providers and nurses both formal training and real-time training opportunities. Real-time training occurred frequently, complemented formal training, and was perceived to have many advantages.
农村急诊科面临的严重紧急情况数量少且具有间歇性，这使得规划和提供相关专业培训变得困难。远程医疗为培训农村急诊科临床医生提供了多种途径。本研究探讨了远程医疗如何通过结构化和非结构化方法为农村急诊科的专业培训做出贡献。这项定性研究考察了美国中西部6个州18家医院的培训经历，这些医院参与了一个单一的中心辐射型远程医疗网络。对7名医生、10名高级执业提供者和11名护士进行了28次访谈。采用标准的归纳定性分析方法，确定与基于远程医疗的培训经历及其对农村急诊科实践的影响相关的关键主题。对于结构化的正式培训，农村急诊科临床医生使用异步课程的频率高于现场课程。据报道，由于时间和工作量的限制，正式培训项目可能没有得到充分利用。农村临床医生非常重视远程医疗会诊期间的非结构化实时培训。各专业群体一致认为，实时培训频繁发生，其自发性是有益的。中心提供者恭敬地提出建议并解释建议背后的理由，促进了实时学习。农村提供者和护士认识到实时培训的几个效果，包括使农村实践与时俱进、增强信心和提高绩效。我们的研究表明，远程医疗为农村急诊科提供者和护士提供了正式培训和实时培训机会。实时培训频繁发生，补充了正式培训，并且被认为有许多优点。
