As we go through our careers, we are given the responsibility of educating the next generation of students and residents to become proficient and competent in medicine. In telehealth, which also requires training my colleagues, is it necessary? If so, what should be part of it? Part of the equivocation with this question of creating telehealth education is at the core of the practice: since I strongly stress that telehealth is a way of practicing medicine rather than a new branch of medicine, what real need is there for creating education?
We are talking about this from some experience. Our program is all encompassing: We run a number of telehealth programs so we have created education for different levels including administrators, medical students, residents, a fellowship and for our faculty. Most of the curriculum entails the basics of telehealth, regulatory, webside manner, basic tech, and troubleshooting and how to go through a visit.
It turns out there are some necessary parts of training, and it depends on who you are educating. This sounds intuitive but, for example, we assumed that because younger generations were better at tech, they would take more easily to telehealth visits. It turns out more experienced physicians convert their practice online much more easily. Meaning it takes less time to train someone on tech than it does to train and get experience as a physician. Technology savviness isn’t a replacement for clinical experience.
For anyone looking for tips on the clinical aspect or learning how to do a visit, some of the education and training I’ve found to be necessary in my experience fall into the following large buckets:
1. Technology. Basics that include how to download apps, using a camera and microphone, basic troubleshooting when things aren’t working.
2. “Webside” manner: a translation of bedside manner to video. How to look at the camera, have an appropriate background, and create a professional environment.
This actually takes practice since it can be awkward initially. Some of the concerns that good bedside manner is more difficult on video is not necessarily true. If you’re good at bedside manner, yes, it’s easier to translate but practice and setting the stage for success always helps.
3. History and physical exam. Tips on creatively doing an exam over telehealth, utilizing the camera, the patient, and other members of household. How do you get actionable information to make a decision for the next steps? Yes, this is possible. This is such a big topic we created an entire course.
4. Disposition. Follow-up, discharge counseling and planning, and effectively answering patient questions.
Nothing has changed my practice more than having to do this over video. It becomes evident how little patients understand about their disease progression or their discharge instructions until you see them a few days later with questions that should have been preemptively answered. It isn’t necessarily our fault; aside from the time constraints in our clinics and emergency departments, we don’t practice chronic care and don’t always realize what a patient experiences two or three days later. Seeing those gaps made me counsel my ED patients more thoroughly and changed what I highlighted. This is a valuable skill that I learned on video and translated back to my in-person practice.
We are still improving our education and training as we change our uses of telehealth and evaluate the gaps and needs of our various learners. There is an art to telehealth and as more people come onboard, we’re going to learn even more creative ways to use this modality for better, more efficient health care.
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