Jones Sarah, McNeil Melissa, Rothenberger Scott D, Jeong Kwonho, Nikiforova Tanya
Assistant Professor, Division of General Internal Medicine, University of Pittsburgh School of Medicine.
Professor and Clinician Educator, Department of Medicine, The Warren Alpert Medical School of Brown University.
MedEdPORTAL. 2025 Jul 8;21:11540. doi: 10.15766/mep_2374-8265.11540. eCollection 2025.
Since the COVID-19 pandemic, internal medicine (IM) residents have provided patient care via telemedicine in their continuity clinics but often without formal training in telemedicine skills. To address this education gap, we developed a two-part curriculum to improve IM residents' self-perceived competence with outpatient telemedicine skills.
From May to August 2020, IM residents participated in a 45-minute interactive case-based, small-group discussion focused on patient triage, virtual physical examination, and telemedicine communication skills. Faculty preceptors directly observed resident telemedicine visits and provided residents with formative feedback using a checklist. Residents completed pre- and postsession surveys assessing self-perceived competence with 15 telemedicine skills.
A total of 119 residents participated in the case-based session, and most (61%) received direct observation. Among these residents, 51% (61/119) completed both pre- and postsession surveys. After completing the curriculum, residents' self-perceived competence increased for all skills, with the largest gains in triaging patients to visit types, physical exam adaptation, addressing preventative care, and arranging follow-up (mean 0.5 increase in participant ratings based on 5-point Likert scale; < .001). Improvement in self-perceived competence was independent of resident level of training and video visit volume. Faculty performing direct observations expressed high levels of confidence in the care delivered.
This easily implemented curriculum combining a case-based discussion with direct observation increased IM residents' self-perceived competence in telemedicine skills and could be readily adopted in IM residency programs and various specialties to provide trainees with telemedicine skills.
自新冠疫情以来，内科住院医师在其连续性门诊通过远程医疗提供患者护理，但往往未接受过远程医疗技能的正规培训。为弥补这一教育差距，我们开发了一个分为两部分的课程，以提高内科住院医师对门诊远程医疗技能的自我认知能力。
2020年5月至8月，内科住院医师参加了一次45分钟基于案例的互动式小组讨论，重点是患者分诊、虚拟体格检查和远程医疗沟通技能。教员直接观察住院医师的远程医疗问诊，并使用检查表为住院医师提供形成性反馈。住院医师完成了课前和课后调查，评估他们对15项远程医疗技能的自我认知能力。
共有119名住院医师参加了基于案例的课程，大多数（61%）接受了直接观察。在这些住院医师中，51%（61/119）完成了课前和课后调查。完成课程后，住院医师对所有技能的自我认知能力均有所提高，在将患者分诊到就诊类型、调整体格检查、处理预防保健和安排随访方面提升最大（基于5点李克特量表，参与者评分平均提高0.5；<.001）。自我认知能力的提高与住院医师的培训水平和视频问诊量无关。进行直接观察的教员对所提供的护理表达了高度信心。
这个易于实施的课程将基于案例的讨论与直接观察相结合，提高了内科住院医师对远程医疗技能的自我认知能力，并且可以很容易地在内科住院医师培训项目和各个专业中采用，为学员提供远程医疗技能。
