From Bedside to Web-Side: The 4 Challenges of Developing a Forward-Looking Telehealth Curriculum

Today’s medical students will encounter telemedicine in their clinical careers, and the academic medical community faces various challenges to keep pace with the growing need for telemedicine training. In their efforts to develop the much-needed telehealth curricula, medical educators need to answer some key questions: what to teach, when to teach, how to teach students, and how to teach the teachers.

What to Teach: Core Telehealth Competencies

Telehealth training has been characterized by individual pilot projects rather than validated and coordinated guidelines or national regulations. To develop a “standard” telehealth curriculum, the academic community needs to agree on what to include in the curricula; in other words, what are the core telehealth competencies? People often say that the current generation of medical students are “digital natives,” but their digital savviness does not automatically translate into competency in the telemedicine space. Educators have outlined some unique competencies for developing telemedicine training programs for practicing physicians, medical students, and other clinicians:¹

• Digital communication and web-side manner
• Scope and standards of care (e.g., billing, insurance, HIPAA compliance)
• Virtual clinical interactions (e.g., virtual physical exam, group interactions)

As the COVID-19 pandemic pushed telehealth into the forefront of healthcare delivery, the Association of American Medical Colleges (AAMC) developed six comprehensive telehealth competencies for medical school graduates, residency graduates, and experienced physicians:²

1. Patient safety and appropriate use of telehealth
2. Access and equity in telehealth
3. Communication via telehealth
4. Data collection and assessment via telehealth
5. Technology for telehealth
6. Ethical practices and legal requirements for telehealth

When to Teach: Preclinical vs. Clerkship Phases

As proposals emerge for developing longitudinal curricula mapped to core telehealth competencies, medical educators must balance the amount of telehealth training in the preclinical and the clerkship phases. In the years leading to the COVID pandemic, the clerkship phase of medical education has been where many medical schools focus most of their telemedicine learning. A 2019 survey shows that whereas more than a quarter of medical schools have preclinical telemedicine training in one or more ways, almost half of the medical schools have found organic ways to incorporate telemedicine exposure into students’ clerkship curricula.³ The use of telemedicine in clerkships has expanded markedly since the pandemic started in early 2020. Over time, as in-person instruction resumed, those who used telemedicine continued it as part of their curricular experiences. However, a relative lack of exposure to telemedicine in the preclinical phase may leave medical students and new residents unprepared in a clinical environment. In fact, researchers say that clerkship learners who experience telemedicine training tend to endorse a need for foundational curricula to include instruction or training on how best to practice telemedicine, which will help deal with technological barriers and reduce stress.⁴

How to Teach Students: The Modality of Training

Academic medical institutions incorporate telemedicine training through various modalities such as lectures, online modules, structured clinical experiences, electives, and standardized patient encounters. In a 3-year longitudinal telehealth curriculum by the Medical University of South Carolina, there is an introduction to telemedicine equipment in the first year, didactic learning through in-person education and online modules in the second year, and experiential learning through remote monitoring of chronic disease in the third year.⁵ Medical schools also use standardized patients to teach the face-to-face skills required to convey good bedside manners. In a survey of 17 medical schools, 10 schools reported utilizing standardized patient encounters to develop telemedicine competencies in medical students.⁶ In one simulation-based research study with 98 medical students, the teaching faculty recorded simulated cases for each student with standardized patients, guided debriefs, and incorporated small-group exercises to teach specific skills in communication and examination. Ninety-two percent of the student participants perceived an improvement in their comfort and ability to conduct video-based patient encounters.⁷

How to Teach the Teachers: Faculty Development

With the increasing needs for telehealth educational resources and training, faculty development becomes a priority for academic medical institutions. The pandemic forced many providers to learn telemedicine “on the fly”; as a result, attending physicians and faculty who themselves had little formal training or experience were tasked with teaching trainees to provide virtual care. A survey of 200 clinicians showed that nearly three-quarters of teaching clinicians agreed that “virtual medicine has made clinical teaching more difficult.” Faculty physicians who precepted trainees during telehealth visits cited “concerns about integrating them into video visit workflows,” “uncertainty about documentation rules,” and uncertainty about how to give trainees feedback on their virtual visit performance as the top 3 barriers.⁸ Currently, limited guidelines exist on the skills that faculty need for effective teaching, observation, and assessment of telehealth competencies. For many teaching physicians and faculty, the three steps of “see one, do one, teach one” are happening simultaneously. In comparison with the active curricular developments for medical students, faculty telehealth curricula often come in bite-sized skills courses with introductory materials and short self-assessments, as seen in the various online telemedicine training from institutions such as American College of Physicians (ACP), American Medical Association (AMA), and Veterans Healthcare Administration (VHA).⁹

Adult learners have great success with experiential learning, a perfect opportunity for incorporating standardized patients. Experiential learning allows participants to see real-time results, which is highly motivating and encouraging, while also provides the opportunity for deep reflection. SP-ed offers an authentic telehealth experience with the ease and flexibility of 1:1 self-scheduled visit at convenient times (mornings, evenings, and weekends). Each session is followed up with a scorecard and verbal feedback with guided self-reflection. If you’re interested in exploring how to add this into your telehealth curriculum, click here to contact us.