Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
Department of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine, New York, NY, USA.
J Gen Intern Med. 2020 Sep;35(9):2675-2679. doi: 10.1007/s11606-020-05979-9. Epub 2020 Jul 8.
Hospital and ambulatory care systems are rapidly building their virtual care capacity in response to the novel coronavirus (COVID-19) pandemic. The use of resident trainees in telemedicine is one area of potential development and expansion. To date, however, training opportunities in this field have been limited, and residents may not be adequately prepared to provide high-quality telemedicine care.
This study evaluates the impact of an adapted telemedicine Objective Structured Clinical Examination (OSCE) on telemedicine-specific training competencies of residents.
Primary Care Internal Medicine residents at a large urban academic hospital.
In March 2020, the New York University Grossman School of Medicine Primary Care program adapted its annual comprehensive OSCE to a telemedicine-based platform, to comply with distance learning and social distancing policies during the COVID-19 pandemic. A previously deployed in-person OSCE on the subject of a medical error was adapted to a telemedicine environment and deployed to 23 primary care residents. Both case-specific and core learning competencies were assessed, and additional observations were conducted on the impact of the telemedicine context on the encounter.
Three areas of telemedicine competency need were identified in the OSCE case: technical proficiency; virtual information gathering, including history, collateral information collection, and physical exam; and interpersonal communication skills, both verbal and nonverbal. Residents expressed enthusiasm for telemedicine training, but had concerns about their preparedness for telemedicine practice and the need for further competency and curricular development.
Programs interested in building capacity among residents to perform telemedicine, particularly during the COVID-19 pandemic, can make significant impact in their trainees' comfort and preparedness by addressing key issues in technical proficiency, history and exam skills, and communication. Further research and curricular development in digital professionalism and digital empathy for trainees may also be beneficial.
为应对新型冠状病毒（COVID-19）大流行，医院和门诊护理系统正在迅速建立虚拟护理能力。在远程医疗中使用住院医师是一个潜在的发展和扩展领域。然而，迄今为止，该领域的培训机会有限，并且住院医师可能无法充分准备提供高质量的远程医疗护理。
本研究评估了改编后的远程医疗客观结构化临床考试（OSCE）对住院医师远程医疗特定培训能力的影响。
大型城市学术医院的初级保健内科住院医师。
2020 年 3 月，纽约大学格罗斯曼医学院初级保健计划将其年度综合 OSCE 改编为基于远程医疗的平台，以遵守 COVID-19 大流行期间的远程学习和社交距离政策。对主题为医疗错误的现有现场 OSCE 进行了改编，以适应远程医疗环境，并部署给 23 名初级保健住院医师。评估了特定病例和核心学习能力，并对远程医疗环境对就诊的影响进行了额外观察。
在 OSCE 案例中确定了远程医疗能力的三个需求领域：技术熟练程度；虚拟信息收集，包括病史，辅助信息收集和体检；以及口头和非口头的人际沟通技巧。住院医师对远程医疗培训表示热情，但对他们准备进行远程医疗实践以及对进一步的能力和课程发展的需求表示关注。
计划在住院医师中建立远程医疗能力的机构，尤其是在 COVID-19 大流行期间，可以通过解决技术熟练程度，病史和检查技能以及沟通方面的关键问题，对住院医师的舒适度和准备情况产生重大影响。对住院医师的数字专业精神和数字同理心进行进一步的研究和课程开发也可能会有所帮助。
