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Coleman C, Ziniel S, Schinasi D, DuBose-Morris R. Advances in Pediatric Telehealth Education and Training: A National Survey. Telemed J E Health 2024. [PMID: 38916876 DOI: 10.1089/tmj.2024.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background: The COVID-19 pandemic accelerated the formal integration of telehealth into education curricula and training programs, prompting the need to reevaluate the current landscape and inform a research agenda. We developed a survey to assess telehealth education and training curriculum, competencies, certification, and research across pediatric medical centers. Methods: Questions were derived from a previously published national survey and de novo. The survey was distributed across national pediatric professional associations. Results: In total, 32 respondents representing medical centers (86.5%) were providing telehealth education and/or training. Most were internally developed didactic (78.6%) and experiential (64.3%) curricula. Respondents who included education and/or training in telehealth research protocols and conducted telehealth research (74%) reported mandatory or optional training in tele-research. A form of certification was preferred by most organizations (>60%). Conclusion: Telehealth education and training are key factors within current and future service development, provision, and research to demonstrate competencies and positively impact patient care.
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Affiliation(s)
- Christina Coleman
- Department of Pediatric Critical Care, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Sonja Ziniel
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Dana Schinasi
- Department of Pediatrics, Digital Health Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ragan DuBose-Morris
- College of Health Professions Medical University of South Carolina, Charleston, South Carolina, USA
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Raffa BJ, Muellers KA, Andreadis K, Ancker JS, Flower KB, Horowitz CR, Kaushal R, Lin JJ. A Qualitative Study on Using Telemedicine for Precepting and Teaching in the Academic Setting. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1204-1210. [PMID: 37279450 DOI: 10.1097/acm.0000000000005291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To examine the impact of telemedicine use on precepting and teaching among preceptors and patients during the COVID-19 pandemic. METHOD The authors conducted a secondary analysis of a qualitative study focusing on providers' and patients' experiences with and attitudes toward telemedicine at 4 academic health centers. Teaching and precepting were emergent codes from the data and organized into themes. Themes were mapped to domains from the 2009 Consolidated Framework for Implementation Research (CFIR), a framework that assists with effective implementation and consists of 5 domains: intervention characteristics, outer settings, inner settings, characteristics of individuals, and process. RESULTS In total, 86 interviews were conducted with 65 patients and 21 providers. Nine providers and 3 patients recounted descriptions related to teaching and precepting with telemedicine. Eight themes were identified, mapping across all 5 CFIR domains, with the majority of themes (n = 6) within the domains of characteristics of individuals, processes, and intervention characteristics. Providers and patients described how a lack of prepandemic telemedicine experience and inadequate processes in place to precept and teach with telemedicine affected the learning environment and perceived quality of care. They also discussed how telemedicine exacerbated existing difficulties in maintaining resident continuity. Providers described ways communication changed with telemedicine use during the pandemic, including having to wear masks while in the same room as the trainee and sitting closely to remain within range of the camera, as well as the benefit of observing trainees with the attending's camera off. Providers expressed a lack of protected structure and time for teaching and supervising with telemedicine, and a general view that telemedicine is here to stay. CONCLUSIONS Efforts should focus on increasing knowledge of telemedicine skills and improving processes to implement telemedicine in the teaching setting in order to best integrate it into undergraduate and graduate medical education.
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Affiliation(s)
- Brittany J Raffa
- B.J. Raffa is clinical instructor and NRSA Primary Care Research Fellow, Department of Pediatrics, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kimberly A Muellers
- K.A. Muellers is a clinical research coordinator, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, and a PhD student, Department of Psychology, Pace University, New York, New York
| | - Katerina Andreadis
- K. Andreadis is a PhD student, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Jessica S Ancker
- J.S. Ancker is professor and vice chair for educational affairs, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kori B Flower
- K.B. Flower is professor and division chief, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carol R Horowitz
- C.R. Horowitz is founding director, Institute for Health Equity Research, and professor, Division of General Internal Medicine and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rainu Kaushal
- R. Kaushal is senior associate dean of clinical research, Nanette Laitman Distinguished Professor, and chair, Department of Population Health Sciences, Weill Cornell Medicine, and physician-in-chief, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jenny J Lin
- J.J. Lin is professor, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Robbins E, Johal K, Keswani A. The Use and Teaching of Telemedicine in Allergy/Immunology Training Programs. Curr Allergy Asthma Rep 2023; 23:463-470. [PMID: 37418070 DOI: 10.1007/s11882-023-01096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE OF REVIEW The use of telemedicine has greatly increased since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This review discusses the types of telemedicine, current telehealth curricula in medical education, and benefits and disadvantages of incorporation of telemedicine into Allergy/Immunology training programs. RECENT FINDINGS The majority of Allergists/Immunologists use telemedicine in their clinical practice with leaders in graduate medical education recommending inclusion of telemedicine in training. Fellows-in-training reported that use of telemedicine in Allergy/Immunology training during the pandemic mitigated some concerns for lack of adequate clinical experience. Still, no standardized curriculum for telemedicine training in Allergy/Immunology exists, although curricula from internal medicine and primary care residencies can provide a framework for incorporation of telemedicine training into fellowship. Benefits of telemedicine in Allergy/Immunology training include enhanced immunology training, home environment monitoring, and flexibility to reduce physician burnout while disadvantages include limited physical examination skill building and lack of a standardized curriculum. As telemedicine has been widely accepted in medicine with high patient satisfaction, it is necessary to incorporate a standardized telehealth curriculum in Allergy/Immunology fellowship training, both as a tool for patient care as well as trainee education.
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Affiliation(s)
- Emily Robbins
- National Institute of Allergy and Immunology, National Institute of Health, Bethesda, MD, USA
| | - Kirti Johal
- Division of Allergy/Immunology, George Washington University School of Medicine and Health Sciences, 2300 M St NW, Suite 200, Washington, DC, 20037, USA
| | - Anjeni Keswani
- Division of Allergy/Immunology, George Washington University School of Medicine and Health Sciences, 2300 M St NW, Suite 200, Washington, DC, 20037, USA.
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Ray KN, Wittman SR, Yabes JG, Sabik LM, Hoberman A, Mehrotra A. Telemedicine Visits to Children During the Pandemic: Practice-Based Telemedicine Versus Telemedicine-Only Providers. Acad Pediatr 2023; 23:265-270. [PMID: 35589062 PMCID: PMC9666718 DOI: 10.1016/j.acap.2022.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In March 2020, regulatory and payment changes allowed "brick and mortar" pediatric practices to offer practice-based telemedicine for the first time, joining direct-to-consumer (DTC) telemedicine vendors in the ability to offer visits for common acute pediatric concerns via telemedicine. We sought to characterize the relative contribution of practice-based telemedicine versus commercial DTC telemedicine models in provision of children's telemedicine from 2018 through 2021. METHODS Using January 2018 to September 2021 data from Optum's de-identified Clinformatics® Data Mart Database, we identified telemedicine visits by children ≤17, excluding preventive visits and visits to specialists, emergency departments, and urgent care. Among included visits, we defined "telemedicine-only" providers as those with ≥80% of visits via telemedicine and practice-based telemedicine providers as those with ≤50% of visits via telemedicine. We then described the telemedicine visit volume and diagnoses for these categories overall and per 1000 children per month. RESULTS From January 2018 to February 2020, telemedicine-only providers accounted for 57,815 telemedicine visits (90.8%), while practice-based telemedicine accounted for 4192 telemedicine visits (6.6%). From March 2020 to September 2021, telemedicine-only providers accounted for 38,282 telemedicine visits (6.1%), while practice-based telemedicine accounted for 555,125 telemedicine visits (88.2%). Per month, telemedicine visits to practice-based telemedicine providers increased from pre-pandemic to pandemic periods (0.1 vs 12.9 visits per 1000 children/month), while telemedicine visits to telemedicine-only providers occurred at a similar rate from pre-pandemic to pandemic periods (0.92 vs 0.96 visits per 1000 children/month). CONCLUSIONS We observed a large increase in telemedicine visits during the pandemic, with the growth in visits exclusively occurring among visits to practice-based telemedicine providers as opposed to telemedicine-only providers.
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Affiliation(s)
- Kristin N Ray
- Department of Pediatrics (KN Ray, SR Wittman, and A Hoberman), University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.
| | - Samuel R Wittman
- Department of Pediatrics (KN Ray, SR Wittman, and A Hoberman), University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Jonathan G Yabes
- Department of Medicine (J Yabes), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Lindsay M Sabik
- Department of Health Policy & Management ( L Sabik), University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa
| | - Alejandro Hoberman
- Department of Pediatrics (KN Ray, SR Wittman, and A Hoberman), University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa
| | - Ateev Mehrotra
- Department of Health Care Policy (A Mehrotra), Harvard Medical School, Boston, Mass
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Aylor M, Poitevien P, Pitt MB. Annual Vision Check: A 2022 Year in (Re)View from the APPD. Acad Pediatr 2023; 23:233-235. [PMID: 36581097 DOI: 10.1016/j.acap.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Megan Aylor
- Division of Pediatric Hospital Medicine, Department of Pediatrics (M Aylor), Oregon Health & Science University & Doernbecher Children's Hospital, Portland, Ore
| | - Patricia Poitevien
- Division of Pediatric Hospital Medicine, Department of Pediatrics (P Poitevien), Warren Alpert Medical School at Brown University & Hasbro Children's Hospital, Providence, RI
| | - Michael B Pitt
- Division of Pediatric Hospital Medicine, Department of Pediatrics (MB Pitt), University of Minnesota School of Medicine & M Health Fairview Masonic Children's Hospital, Minneapolis, Minn.
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Muacevic A, Adler JR, Shealy R. Bridging the Gap in Graduate Medical Education: A Longitudinal Analysis of Medical and Fellowship Director Experiences in Telehealth. Cureus 2022; 14:e31947. [PMID: 36582562 PMCID: PMC9794914 DOI: 10.7759/cureus.31947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background With the evolving nature of telehealth services being supported across graduate medical programs, understanding changing attitudes among program directors is essential for training future physicians. Objective This 5-year longitudinal survey analysis provides details regarding the knowledge, skills, competency, and confidence levels present among program directors and the ways telehealth training (didactic and experiential) supports resident education. Methods A longitudinal observation survey was sent to 77 program directors (48% completion) from an academic health system. Data were compared from survey responses from 2016 to 2021 with additional information collected about current training processes in 2021. Paired sample t-tests, quantitative data analysis, and qualitative thematic analysis results are reported based on a convenience sampling of all program and fellowship directors. Results Results show that while telehealth knowledge and use increased among program director faculty, systemic concerns about the feasibility of telehealth from a time and cost perspective remain high. In 2016 and 2021, most of those surveyed (28.9% and 37.1%, respectively) were concerned about reimbursement. Directors remain committed to telehealth resident education, with over 60% stating that it is "essential to future practice". The qualitative thematic analysis highlighted the need for additional resources and support to conduct telehealth and the variability within disciplines of the use, therefore modeling, of telehealth in clinical settings. Conclusions The overall utilization of telehealth by graduate medical education programs has increased along with the continued need for training to prepare residents for current and future practice.
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Haynes SC, Marcin JP. Pediatric Telemedicine: Lessons Learned During the Coronavirus Disease 2019 Pandemic and Opportunities for Growth. Adv Pediatr 2022; 69:1-11. [PMID: 35985702 PMCID: PMC8979775 DOI: 10.1016/j.yapd.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The accelerated uptake of telemedicine during the coronavirus disease 2019 pandemic has resulted in valuable experience and evidence on the delivery of telemedicine for pediatric patients. The pandemic has also highlighted inequities and opportunities for improvement. This review discusses lessons learned during the pandemic, focusing on provider-to-patient virtual encounters. Recent evidence on education and training, developing and adapting clinical workflows, patient assessment and treatment, and family-centered care is reviewed. Opportunities for future research in pediatric telemedicine are discussed, specifically with regard to engaging pediatric patients, improving and measuring access to care, addressing health equity, and expanding the evidence base.
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Affiliation(s)
- Sarah C Haynes
- Department of Pediatrics, UC Davis School of Medicine, UC Davis Center for Health and Technology, 4610 X Street, Suite 2300, Sacramento, CA 95817, USA.
| | - James P Marcin
- Department of Pediatrics, UC Davis School of Medicine, UC Davis Center for Health and Technology, 4610 X Street, Suite 2300, Sacramento, CA 95817, USA
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