Wong Rachel, Ng Patricia, Spinnato Tracey, Taub Erin, Kaushal Amit, Lerman Mark, Fernan Alice, Dainer Erin, Noel Kimberly
Assistant Professor, Division of General, Geriatrics, and Hospital Medicine, Stony Brook University Hospital.
Biostatistician, Department of Medicine, Stony Brook University Hospital.
J Grad Med Educ. 2020 Dec;12(6):745-752. doi: 10.4300/JGME-D-20-00030.1. Epub 2020 Dec 4.
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, < .0001), e-messaging (pre 36%, 95% CI 24-49 vs post-2 80%, 95% CI 70-91, < .0001), and coordinating interdisciplinary care (pre 35%, 95% CI 22-47 vs post-2 84%, 95% CI 74-94, < .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, = .001).
A longitudinal, interdisciplinary telehealth simulation is feasible and can improve residents' confidence in using telemedicine to provide complex patient care.
尽管远程医疗的使用日益增加，但针对初级保健提供者利用远程医疗提供复杂的跨学科护理的已发表课程却很有限。
描述并评估一个带有纵向客观结构化临床考试（OSCE）的远程医疗课程，以提高内科住院医师通过视频问诊、电子会诊和电话会议协调复杂跨学科初级保健的信心和技能。
2019年，56名一年级和三年级住院医师参加了一个为期5周、分为三个部分的OSCE，培训他们使用远程医疗来管理复杂的初级保健。学习者在第一阶段进行标准化患者（SP）视频问诊，通过问诊间的电子信息协调护理，并在第二阶段主持一次模拟的跨学科电话会议。在第一阶段前（pre）、第一阶段后（post-１）和第二阶段后（post-２）进行调查以测量信心。SP视频问诊清单和调查人员对电子信息的评估用于评估住院医师的远程医疗技能。
回复率分别为pre阶段100%、post-1阶段95%（56人中的53人）和post-2阶段100%。干预后，更多住院医师对调整摄像头（33%，95%CI 20-45 vs 85%，95%CI 75-95，P<0.0001）、电子信息沟通（pre阶段36%，95%CI 24-49 vs post-2阶段80%，95%CI 70-91，P<0.0001）以及协调跨学科护理（pre阶段35%，95%CI 22-47 vs post-2阶段84%，95%CI 74-94，P<0.0001）“有信心/非常有信心”。更多住院医师“可能/非常可能”在未来使用远程医疗（pre阶段56%，95%CI 43-69，vs post-2阶段79%，95%CI 68-89，P=0.001）。
一个纵向的、跨学科的远程医疗模拟是可行的，并且可以提高住院医师使用远程医疗提供复杂患者护理的信心。
