Putting the Cart before the Horse: Outcomes Following Rapid Implementation of Telepsychiatry in an Outpatient Resident C
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EDUCATIONAL CASE REPORT
Putting the Cart before the Horse: Outcomes Following Rapid Implementation of Telepsychiatry in an Outpatient Resident Clinic Samar McCutcheon 1 Received: 11 June 2020 / Accepted: 8 September 2020 # Academic Psychiatry 2020
Historically, telepsychiatry has most often been instituted as a method to expand access of psychiatric services to patients, primarily in rural areas with a paucity of psychiatric services or as a means for patients to gain access to subspecialty psychiatric care [1–3]. In those contexts, previous studies of telepsychiatry have demonstrated similar efficacy and patient satisfaction with video visits when compared with face-to-face encounters [4–6]. Systemic reviews have established that few residency programs have formal, longitudinal telepsychiatry curriculums, but telepsychiatry education has historically been an area of interest within residency programs; up to 85% of residency programs responding to a telepsychiatry survey by Hoffman and Kane expressed interest in a sample curriculum [7–9]. The Accreditation Council for Graduate Medical Education (ACGME) does not have specific requirements surrounding telemedicine in the psychiatry common program requirements, but it has been posited that exposure to telepsychiatry during training could increase resident competence and comfort with providing care utilizing this modality after graduation [10, 11].
Implementation of Telepsychiatry With the adjustments to patient care made in the face of the COVID-19 pandemic, telepsychiatry shifted overnight from a topic touched upon briefly in didactics at our program to the default method of practicing outpatient psychiatry in our resident clinic. We are aware that this was the shared experience of several psychiatry residency programs across the nation, facilitated by the loosening of pre-existing federal and state * Samar McCutcheon [email protected] 1
The Ohio State University College of Medicine, Columbus, OH, USA
regulations that had often served as barriers to telepsychiatry [12]. Ideally, extensive education and thorough training proceed the introduction of any new practice delivery method in residency training. If implementing telepsychiatry had been a planned transition, attendings would have reviewed the existing literature of evidence-based practices and piloted the method; residents would then be introduced to the process with background reading and lectures, transitioning to practice once attendings were capable and competent to supervise. With COVID-19, our residency was forced to put the “cart” of patient care before the “horse” of education and training. On March 17, 2020, all scheduled outpatient visits in postgraduate year 3 (PGY-3) resident clinic at The Ohio State University Wexner Medical Center were converted from face-to-face encounters to telephone visits. Telephone visits were the standard as the medical center worked to obtain sufficient telemedicine licenses and webcams to outfit each computer. On April 6, 2020, these requirements were met, an
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