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Goglin S, Kolfenbach J. The Impact of COVID-19 on Education and Training in Rheumatology: A Narrative Review. Arthritis Care Res (Hoboken) 2024; 76:32-39. [PMID: 37849427 DOI: 10.1002/acr.25258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
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Bolster MB, Kolfenbach J, Poeschla A, Criscione-Schreiber L, Hant F, Ishizawar R, Jonas B, Leverenz D, O'Rourke KS, Wolfe RM, Zickuhr L. Incorporating Telemedicine in Rheumatology Fellowship Training Programs: Needs Assessment, Curricular Intervention, and Evaluation. Arthritis Care Res (Hoboken) 2023; 75:2428-2434. [PMID: 37232060 DOI: 10.1002/acr.25165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/07/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To increase the confidence of rheumatology fellows in training (FITs) in delivering virtual care (VC) and prepare them for independent practice, we developed educational materials addressing gaps in their skills. METHODS We identified gaps in telemedicine skills based on FIT performance in a virtual rheumatology objective structured clinical examination (vROSCE) station on VC delivery using video teleconference technology and survey (survey 1) responses. We created educational materials including videos of "mediocre" and "excellent" VC examples, discussion/reflection questions, and a document summarizing key practices. We measured change in the confidence levels of FITs for delivering VC with a post-intervention survey (survey 2). RESULTS Thirty-seven FITs (19 first-year, 18 second- plus third-year fellows) from 7 rheumatology fellowship training programs participated in a vROSCE and demonstrated gaps in skills mapping to several Rheumatology Telehealth Competency domains. Confidence levels of FITs improved significantly from survey 1 to survey 2 for 22 of 34 (65%) questions. All participating FITs found the educational materials helpful for learning and reflecting on their own VC practice; 18 FITs (64%) qualified usefulness as "moderately" or "a lot." Through surveying, 17 FITs (61%) reported implementing skills from the instructional videos into VC visits. CONCLUSION Continually assessing our learners' needs and creating educational materials addressing gaps in training are requisite. Using a vROSCE station, needs assessments, and targeted learning with videos and discussion-guidance materials enhanced the confidence level of FITs in VC delivery. It is imperative to incorporate VC delivery into fellowship training program curricula to ensure breadth in skills, attitudes, and knowledge of new entrants into the rheumatology workforce.
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Affiliation(s)
| | | | | | | | - Faye Hant
- Medical University of South Carolina, Charleston
| | | | - Beth Jonas
- University of North Carolina at Chapel Hill
| | | | | | - Rachel M Wolfe
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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3
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Kayaalp GK, Akgün Ö, Demirkan FG, Tanatar A, Çakmak F, Ayaz NA. Parent Views on Telemedicine in Pediatric Rheumatology: A Survey Study. Telemed J E Health 2023; 29:1548-1556. [PMID: 36800172 DOI: 10.1089/tmj.2022.0433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Objectives: The rapid expansion in the use of telemedicine after the COVID-19 pandemic has led many patients with chronic diseases to seek alternative ways for follow-ups. This study aimed to investigate the demands and opinions of parents of children with rheumatic diseases toward telemedicine and to examine the factors affecting telemedicine preference. Methods: A single-center, cross-sectional, Web-based survey study was conducted. Sociodemographic data, characteristics of the disease, access to the clinic, internet use, and views on telemedicine were assessed. Factors effecting telemedicine preference were evaluated by multivariate analysis. Results: A total of 245 parents have completed the survey. The diagnoses of patients were recurrent fever syndromes (55.1%), juvenile idiopathic arthritis (31.0%), systemic connective tissue diseases (8.2%), and vasculitis (5.7%). The majority of patients came to the clinic by public transport (n = 190, 77.6%). Sixty-eight (27.8%) patients missed at least one outpatient appointment in the last year. Majority (n = 172, 70.2%) of parents stated that they would prefer telemedicine visits if it becomes available. Multivariate analysis revealed that the most related factors to telemedicine preference were higher education level (odds ratio [OR]: 6.69, confidence interval [95% CI]: 2.21-20.25, p = 0.001), missing an appointment (OR: 3.04, 95% CI: 1.41-6.56, p = 0.004), and travel time longer than 1 h (OR: 2.13, 95% CI: 1.13-3.86, p = 0.012). Conclusion: Telemedicine visits are in demand in pediatric rheumatology and should be considered an alternative method to ensure continuity of patient follow-up. A personal approach should be followed when selecting patients for telemedicine.
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Affiliation(s)
- Gülşah Kavrul Kayaalp
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Özlem Akgün
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Tharwat S, Gamal D. The Attitude of Egyptian Patients with Autoimmune and Rheumatic Diseases towards Telemedicine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1595. [PMID: 37763714 PMCID: PMC10533084 DOI: 10.3390/medicina59091595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The use of telemedicine (TM) has recently undergone rapid growth and proliferation. Professional stakeholders anticipate that TM will aid in the efficient allocation of limited resources in rheumatology care. The aim of the study was to evaluate the acceptance and willingness of Egyptian patients with autoimmune and rheumatic diseases (ARDs) to incorporate TM into rheumatological care and to assess their requirements and concerns regarding TM. Materials and Methods: A cross-sectional questionnaire-based study was conducted among Egyptian patients with ARDs. The questionnaire covered sociodemographic characteristics, clinical and therapeutic data, attitudes, barriers, and motivators towards TM. Results: The study included 189 patients with ARDs, with a mean age of 37 years (SD = 11.71), and 88.4% were females. Participants were divided into two groups based on their acceptance of TM: the non-acceptant group (133, 70.4%) and the acceptant group (56, 29.6%). There was a significant difference in educational level (p = 0.001), chronic kidney and heart disease (p = 0.008 and 0.014, respectively) and hydroxychloroquine administration (p = 0.037) between the two groups. During the coronavirus disease 2019 (COVID-19) pandemic, 96 (50.8%) of participants used virtual rheumatology consultations, mainly using WhatsApp (64.6%). Approximately 87% would require assistance in operating TM technology. The preference for direct conversation with the rheumatologist and the need for physical examination were the main barriers to teleconsultation. Conclusions: TM is opposed by the vast majority of Egyptian patients with ARDs. They are concerned since it does not include a physical examination and prevents them from undergoing additional procedures such as ultrasound and blood testing. The majority of Egyptian patients with ARDs need help using TM technology, which is the most significant barrier to the spread of TM.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt
| | - Doaa Gamal
- Mansoura Manchester Programme for Medical Education, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt;
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Calabrese L, Battafarano DF, Stamatos C, Saag KG. "Burnout" Coupled with Workforce Shortages Spells Trouble: Innovative Solutions Are Essential for More Satisfying Rheumatology Practice. Arthritis Rheumatol 2023; 75:1499-1502. [PMID: 37096452 DOI: 10.1002/art.42537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
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Kaushik P, Bastible S, Marak C. On telemedicine in rheumatology, with a pedagogical implementation from rural Oklahoma: comment on the article by Lockwood et al. Arthritis Care Res (Hoboken) 2023; 75:1385-1386. [PMID: 36303521 DOI: 10.1002/acr.25051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Prashant Kaushik
- Northeastern Health System, Oklahoma State University College of Osteopathic Medicine Center for Health Sciences at the Cherokee Nation, and Northeastern Health System, Tahlequah, OK
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Demaerschalk BM, Hollander JE, Krupinski E, Scott J, Albert D, Bobokalonova Z, Bolster M, Chan A, Christopherson L, Coffey JD, Edgman-Levitan S, Goldwater J, Hayden E, Peoples C, Rising KL, Schwamm LH. Quality Frameworks for Virtual Care: Expert Panel Recommendations. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 7:31-44. [PMID: 36619179 PMCID: PMC9811201 DOI: 10.1016/j.mayocpiqo.2022.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Given the significant advance of virtual care in the past year and half, it seems timely to focus on quality frameworks and how they have evolved collaboratively across health care organizations. Massachusetts General Hospital's (MGH) Center for TeleHealth and Mass General Brigham's (MGB) Virtual Care Program are committed to hosting annual symposia on key topics related to virtual care. Subject matter experts across the country, health care organizations, and academic medical centers are invited to participate. The inaugural MGH/MGB Virtual Care Symposium, which focused on rethinking curriculum, competency, and culture in the virtual care era, was held on September 2, 2020. The second MGH/MGB Virtual Care Symposium was held on November 2, 2021, and focused on virtual care quality frameworks. Resultant topics were (1) guiding principles necessary for the future of virtual care measurement; (2) best practices deployed to measure quality of virtual care and how they compare and align with in-person frameworks; (3) evolution of quality frameworks over time; (4) how increased adoption of virtual care has impacted patient access and experience and how it has been measured; (5) the pitfalls and barriers which have been encountered by organizations in developing virtual care quality frameworks; and (6) examples of how quality frameworks have been applied in various use cases. Common elements of a quality framework for virtual care programs among symposium participants included improving the patient and provider experience, a focus on achieving health equity, monitoring success rates and uptime of the technical elements of virtual care, financial stewardship, and clinical outcomes. Virtual care represents an evolution in the access to care paradigm that helps keep health care aligned with other modern industries in digital technology and systems adoption. With advances in health care delivery models, it is vitally important that the quality measurement systems be adapted to include virtual care encounters. New methods may be necessary for asynchronous transactions, but synchronous virtual visits and consults can likely be accommodated in traditional quality frameworks with minimal adjustments. Ultimately, quality frameworks for health care will adapt to hybrid in-person and virtual care practices.
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Affiliation(s)
- Bart M. Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science and Center for Digital Health, Mayo Clinic, Phoenix, AZ,Correspondence: Address to Bart M. Demaerschalk, MD, M.Sc., Mayo Clinic College of Medicine and Science and Center for Digital Health Mayo Clinic, Phoenix, 13400 East Shea Boulevard, Scottsdale, AZ 85259.
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Elizabeth Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
| | | | - Daniel Albert
- Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Marcy Bolster
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Albert Chan
- Department of Medicine, Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA
| | - Laura Christopherson
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jordan D. Coffey
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Susan Edgman-Levitan
- The John D. Stoekle Center for Primary Care Innovation, Massachusetts General Hospital, Boston, MA
| | | | - Emily Hayden
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | - Kristin L. Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, PA
| | - Lee H. Schwamm
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
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Machado PM, Verschueren P, Grainger R, Jones H, Piercy J, van Beneden K, Caporali R, Dejaco C, Fautrel B. Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries. Rheumatol Adv Pract 2022; 7:rkac108. [PMID: 36601518 PMCID: PMC9800854 DOI: 10.1093/rap/rkac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objective We aimed to describe, from the perspective of rheumatologists in Europe, how the coronavirus disease 2019 (COVID-19) pandemic has impacted their management of people with RA and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific ProgrammeTM in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour and continuing education owing to COVID-19. Results were summarized with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilization of video/telephone consultations (66.5% of respondents), fewer visits (58.5%) and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated that prescribing behaviour had changed switched their patients to self-administered medication, and 60.7% reported not starting patients on targeted synthetic DMARDs, biologic originator DMARDs or biosimilar DMARDs. In total, 57.6% of rheumatologists believed that changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusion All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to prepare better for future pandemics and to address ongoing rheumatologist shortages.
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Affiliation(s)
- Pedro M Machado
- Correspondence to: Pedro M. Machado, Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, 1st Floor, Russell Square House, 10–12 Russell Square, London WC1B 5EH, UK. E-mail:
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Hannah Jones
- Autoimmune Franchise, Adelphi Real World, Bollington, UK
| | - James Piercy
- Health Economics and Outcomes Research, Adelphi Real World, Bollington, UK
| | | | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,Division of Clinical Rheumatology, ASST Pini-CTO, Milan, Italy
| | | | - Bruno Fautrel
- Service de Rhumatologie, Sorbonne Université-Assistance Publique-Hôpitaux de Paris, Paris, France
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Hormaza-Jaramillo A, Arredondo A, Forero E, Herrera S, Ochoa C, Arbeláez-Cortés Á, Fernandez Aldana AR, Rodriguez A, Amador L, Castaño N, Reyes J. Effectiveness of Telemedicine Compared with Standard Care for Patients with Rheumatic Diseases: A Systematic Review. Telemed J E Health 2022; 28:1852-1860. [PMID: 35834601 DOI: 10.1089/tmj.2022.0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: The aim of this study was to systematically review the evidence on the effectiveness of telemedicine compared to standard care for patients with rheumatic diseases. Methods: A search was performed in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews; for the gray literature, GREYNET databases and a snowball search were used. MeSH or Emtree terms. Three authors independently selected systematic reviews, randomized controlled trail (RCTs), or non-RCTs with patients with autoimmune or inflammatory rheumatic diseases, where telemedicine was compared with standard care. Effectiveness was measured in terms of disease activity, quality of life, and functional activity. The patients' satisfaction was also measured. The risk of bias was assessed by the Cochrane collaboration tool for RCTs and AMSTAR II for systematic reviews. Results: Four RCTs, one cross-out study, and five systematic reviews were included. The studies were conducted with rheumatoid arthritis patients, and one study involved patients with systematic lupus erythematosus. The interventions mainly involved teleconsultation and telemonitoring, with patient-reported outcomes (PROs) being compared with standard care. Four studies measured the effectiveness of telemedicine using PROs, in which three of the RCTs did not find differences in the clinical outcomes, and one found that telemedicine improved the remission of diseases, functional impairment, and radiographic joint damage progression. Two studies measured patient satisfaction with telemedicine and standard care without a significant difference between the groups. Conclusions: Despite heterogeneity between studies, the findings were remarkably consistent in demonstrating that there was no significant difference between the telemedicine group and the control group in terms of PROs and patient satisfaction. Patients should be offered the option of telemedicine to manage their diseases as part of health-care support. Further research is needed on the effectiveness of telemedicine in the long term for patients with rheumatic diseases.
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Affiliation(s)
| | - Ana Arredondo
- Internal Medicine and Rheumatology Fundacion Universitaria de Ciencias de la Salud, Bogota, Colombia
- Rheumatology, Hospital de San Jose, Bogota, Colombia
- Rheumatology, Clinicos IPS, Bogota, Colombia
| | - Elias Forero
- Rheumatology, Universidad del Norte, Barranquilla, Colombia
| | - Sebastian Herrera
- Rheumatology, ARTMEDICA, Medellin, Colombia
- Rheumatology, Clinica Las Americas, Medellin, Colombia
| | - Carlos Ochoa
- Rheumatology, Centro de Reumatologia, Bogota, Colombia
| | - Álvaro Arbeláez-Cortés
- Rheumatology, Clinica Imbanaco Grupo Quiron salud, Cali, Colombia
- Internal Medicine, Universidad Libre, Cali, Colombia
| | | | - Andrea Rodriguez
- Clinical Epidemiology, National University of Colombia, Bogota, Colombia
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Dua AB, Bolster MB, Gensler LS, Kolfenbach J, Mamut MH, Seo P, Jonas BL. Virtually Speaking: The Impact of a Nationwide Synchronous and Asynchronous Learning Forum. Arthritis Care Res (Hoboken) 2022. [PMID: 35724301 DOI: 10.1002/acr.24972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/25/2022] [Accepted: 06/14/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To address significant disruptions in didactic education precipitated by the COVID-19 pandemic, a group of rheumatology program directors collaborated with the American College of Rheumatology to create a virtual fellows-in-training (V-FIT) program. METHODS A working group was composed to develop the virtual didactic program comprising live virtual sessions of core curricular rheumatology topics that were recorded to permit asynchronous learning. Nationally recognized educators were invited to lead sessions to fill the void in didactic education occurring on a broad scale across US rheumatology fellowship training programs. Demographic information, live and asynchronous participation data, and feedback surveys were collected from participants in the program. RESULTS There were 3 components to V-FIT: the Virtual Rheumatology Learning (ViRL) series, the Virtual Rheumatology Practicum (ViP), and the Virtual Rheumatology Teaching Lessons (ViTLs). The ViRL program had global impact with more than 2,000 learners from more than 55 countries. ViP provided a standardized curriculum of rheumatology topics for incoming first-year fellows. ViTLs addressed advanced and interdisciplinary rheumatic disease topics for learners at all stages. CONCLUSION With collaboration, adaptation, and innovation, the V-FIT program not only maintained but also enhanced education for rheumatology trainees, was enriched by national and international participation, and provided standardized, broadly accessible content with interdisciplinary learning.
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Affiliation(s)
| | | | | | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
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Saygin D, Lin J, Rolle NA, Mamut M. Report of the American College of Rheumatology Fellows-in-Training Subcommittee: experiences of rheumatology fellows early in the COVID-19 pandemic. Arthritis Rheumatol 2022; 74:1457-1458. [PMID: 35373922 PMCID: PMC9082478 DOI: 10.1002/art.42135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/01/2022] [Accepted: 03/05/2022] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jean Lin
- Northwestern University, Chicago, IL
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12
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Yeoh SA, Young K, Putman M, Sattui S, Conway R, Graef E, Kilian A, Konig M, Sparks J, Ugarte-Gil M, Upton L, Berenbaum F, Bhana S, Costello W, Hausmann J, Machado P, Robinson P, Sirotich E, Sufka P, Yazdany J, Liew J, Grainger R, Wallace Z, Jayatilleke A. Rapid Adoption of Telemedicine in Rheumatology Care During the COVID-19 Pandemic Highlights Training and Supervision Concerns Among Rheumatology Trainees. ACR Open Rheumatol 2021; 4:128-133. [PMID: 34791821 PMCID: PMC8652624 DOI: 10.1002/acr2.11355] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/21/2021] [Accepted: 09/08/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the impact of telemedicine use during the coronavirus disease 2019 (COVID-19) pandemic on rheumatology trainees. METHODS A voluntary, anonymous, web-based survey was administered in English, Spanish, or French from August 19 to October 5, 2020. Adult and pediatric rheumatology trainees were invited to participate via social media and email. Using multiple-choice questions and Likert scales, the survey assessed prior and current telemedicine use, impact on training, and supervision after COVID-19 prompted rapid telemedicine implementation. RESULTS Surveys were received from 302 trainees from 33 countries, with 83% in adult rheumatology training programs. Reported telemedicine use increased from 13% before the pandemic to 82% during the pandemic. United States trainees predominantly used video visits, whereas outside the United States telemedicine was predominantly audio only. Most (65%) evaluated new patients using telemedicine. More respondents were comfortable using telemedicine for follow-up patients (69%) than for new patients (25%). Only 39% of respondents reported receiving telemedicine-focused training, including instruction on software, clinical skills, and billing, whereas more than half of United States trainees (59%) had training. Postconsultation verbal discussion was the most frequent form of supervision; 24% reported no supervision. Trainees found that telemedicine negatively impacted supervision (50%) and the quality of clinical teaching received (70%), with only 9% reporting a positive impact. CONCLUSIONS Despite widespread uptake of telemedicine, a low proportion of trainees received telemedicine training, and many lacked comfort in evaluating patients, particularly new patients. Inadequate supervision and clinical teaching were areas of concern. If telemedicine remains in widespread use, ensuring appropriate trainee supervision and teaching should be prioritized.
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Affiliation(s)
| | | | | | | | | | | | - Adam Kilian
- The George Washington University, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | - Emily Sirotich
- Canadian Arthritis Patient Alliance, McMaster University, Hamilton, Ontario, Canada
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Zickuhr L, Kolfenbach J, Bolster MB. Applying Educational Theory to Optimize Trainee Education in the Ambulatory Virtual Care Environment. MEDICAL SCIENCE EDUCATOR 2021; 31:1715-1722. [PMID: 34422453 PMCID: PMC8370462 DOI: 10.1007/s40670-021-01365-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 05/10/2023]
Abstract
Virtual care (VC) encounters have become an essential part of outpatient clinical care. The theory of situated learning and legitimate peripheral participation posits that medical trainees learn best when they participate in authentic patient care experiences and engage effectively with their preceptors, members of the health care team, and the clinical learning environment. This theory can provide a framework from which to approach teaching in the VC setting, whereby preceptors may capitalize on the unique learning and assessment opportunities provided during VC encounters and optimize educational experiences for trainees as well as clinical outcomes for patients. In this monograph, we propose an approach grounded in situated learning and legitimate peripheral participation for teaching in the VC environment, particularly during real-time video visits.
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Affiliation(s)
- Lisa Zickuhr
- Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
| | - Jason Kolfenbach
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO USA
| | - Marcy B. Bolster
- Department of Medicine, Massachusetts General Hospital, Boston, MA USA
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