Building Telemedicine Capacity for Trainees During the Novel Coronavirus Outbreak: a Case Study and Lessons Learned
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Department of Population Health, NYU Grossman School of Medicine , New York , NY , USA; 2Department of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine , New York , NY , USA.
INTRODUCTION: 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. AIM: This study evaluates the impact of an adapted telemedicine Objective Structured Clinical Examination (OSCE) on telemedicine-specific training competencies of residents. SETTING: Primary Care Internal Medicine residents at a large urban academic hospital. PROGRAM DESCRIPTION: 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. PROGRAM EVALUATION: 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. DISCUSSION: 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. KEY WORDS: telemedicine; residency training; Objective Structured Clinical Examination (OSCE); standardized patient; clinical skills assessment; coronavirus; COVID-19. J Gen Intern Med DOI: 10.1007/s11606-020-05979-9 © Society of General Internal Medicine 2020
BACKGROUND
The past several months have seen unprecedented changes in the field of virtual healthcare1. As a result of the novel coronavirus (COVID-19) pandemic and the social distancing policies that have been put into place in an attempt to reduce viral spread, both hospital and ambulatory care systems have made enormous efforts to expand and fortify their virtual care capacity. These efforts parallel
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