Almufleh Aws, Lee Christopher, Tsang Michael Yc, Gin Kenneth, Tsang Teresa S M, Nair Parvathy
Division of Cardiology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
Division of Cardiology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Can J Cardiol. 2021 Jun;37(6):929-932. doi: 10.1016/j.cjca.2021.03.001. Epub 2021 May 12.
COVID-19 brought telemedicine to the forefront of clinical cardiology. We aimed to examine the extent of trainees' involvement in and comfort with telemedicine practices in Canada with the use of a web-based self-administered survey. Eighty-six trainees from 12 training programs completed the survey (65% response rate). Results showed that before COVID-19, 39 trainees (45%) had telemedicine exposure, compared with 67 (78%) after COVID-19 (P < 0.001). However, only 44 trainees (51%) reported being comfortable or very comfortable with the use of telemedicine. Of the 67 trainees who were involved in telemedicine, 4 (6%) had full supervision during virtual visits, 13 (19%) had partial supervision, and 50 (75%) had minimal or no supervision. Importantly, 67 trainees (78%) expressed the need for telemedicine-specific training and 64 (74%) were willing to have their virtual visits recorded for the purpose of evaluation and feedback. Furthermore, 47 (55%) felt strongly or very strongly positive about incorporating telemedicine into their future practice. The main perceived barriers to telemedicine use were concerns about patients' engagement, fear of weakening the patient-physician relationship, and unfamiliarity with telemedicine technology. These barriers, together with training in virtual physical examination skills and medicolegal aspects of telemedicine, are addressed in several established internal medicine telemedicine curricula that could be adapted by cardiology programs. In conclusion, while the degree of telemedicine involvement since COVID-19 was high, the trainees' comfort level with telemedicine practice remains suboptimal likely due to lack of training and inadequate staff supervision. Therefore, a cardiology telemedicine curriculum is needed to ensure that trainees are equipped to embrace telemedicine in cardiovascular clinical care.
新冠疫情使远程医疗成为临床心脏病学的前沿领域。我们旨在通过一项基于网络的自填式调查，探究加拿大实习医生参与远程医疗实践的程度以及他们对远程医疗实践的适应程度。来自12个培训项目的86名实习医生完成了调查（回复率为65%）。结果显示，在新冠疫情之前，有39名实习医生（45%）有过远程医疗接触，而在新冠疫情之后这一数字为67名（78%）（P<0.001）。然而，只有44名实习医生（51%）表示对使用远程医疗感到舒适或非常舒适。在参与远程医疗的67名实习医生中，4名（6%）在虚拟问诊期间得到了全程监督，13名（19%）得到了部分监督，50名（75%）得到的监督极少或没有监督。重要的是，67名实习医生（78%）表示需要接受远程医疗专项培训，64名（74%）愿意为了评估和反馈的目的对他们的虚拟问诊进行录像。此外，47名（55%）对将远程医疗纳入他们未来的实践持非常积极或极其积极的态度。使用远程医疗的主要感知障碍包括对患者参与度的担忧、担心削弱医患关系以及对远程医疗技术不熟悉。这些障碍，连同虚拟体格检查技能培训和远程医疗的法医学方面，在一些已有的内科远程医疗课程中得到了解决，心脏病学项目可以对这些课程进行改编。总之，虽然自新冠疫情以来远程医疗的参与程度很高，但实习医生对远程医疗实践的适应程度仍不理想，这可能是由于缺乏培训和工作人员监督不足。因此，需要一门心脏病学远程医疗课程，以确保实习医生有能力在心血管临床护理中接受远程医疗。
