1
|
Zhou L, Li Y, Zhang Y, Chen X, Zhang S, Hu X. Perceptions of Telehealth Services Among Rural Lung Cancer Patients in China: A Qualitative Study Using the Technology Acceptance Model. Semin Oncol Nurs 2024; 40:151710. [PMID: 39117510 DOI: 10.1016/j.soncn.2024.151710] [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] [Received: 01/15/2024] [Revised: 06/25/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To describe the perceptions of telehealth services among lung cancer patients in rural areas of China, as well as to explore the potential of telemedicine to improve long-term health recovery at home for rural lung cancer patients. METHODS A qualitative descriptive study design was used in this study and we conducted semi-structured interviews with 14 rural Chinese lung cancer patients between December 2022 and March 2023. Interview content was analyzed using Nvivo software and a framework analysis was performed using the Technology Acceptance Model to identify meaningful themes. RESULTS Participants identified perceptual and technical factors related to perceived ease of use, benefits and drawbacks related to perceived usefulness, and facilitators and barriers related to intention to use. However, regional and disease features including literacy barriers, medical insurance condition, symptom burden, and rural cultural health seeking behavior conduct must be taken into account. CONCLUSIONS Lung cancer patients in rural China believe that telehealth services could be an alternative solution for addressing health and care needs, but various aspects, such as user interface design, cost-effectiveness, and technological anxiety, need to be optimized. IMPLICATIONS FOR NURSING PRACTICE More highly specialized nursing team, friendly telecare lung function modules, and media technology training courses should be developed for rural lung cancer patients to enhance the quality of their home care, meet their information needs and better control their disease progression.
Collapse
Affiliation(s)
- Lin Zhou
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yunhuan Li
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yun Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoli Chen
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Shu Zhang
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu, Sichuan, China; Tianfu Jincheng Laboratory, City of Future Medicine, Chengdu, Sichuan, China.
| |
Collapse
|
2
|
Mariño RJ, Capurro D, Merolli M. Pilot implementation of a telehealth course for health professions students. BMC MEDICAL EDUCATION 2024; 24:963. [PMID: 39232771 PMCID: PMC11373492 DOI: 10.1186/s12909-024-05931-z] [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: 02/28/2024] [Accepted: 08/20/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVES This study examined the level of technology proficiency amongst healthcare professions students. Additionally, the study provides an evaluation of the pilot implementation, as well as the effect of a 7-module telehealth course on the level of adoption and future use of telehealth amongst future Australian healthcare workforce. METHODS Students from four health-sciences departments at the University of Melbourne, Australia, participated in this pilot study by completing the course and an online questionnaire, which included both structured and open-ended questions. The questionnaire included: 12-items on socio-demographic and Internet utilization; 34-items about acceptance and use of telehealth adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT2) questionnaire; and 22-items about confidence in using the Internet and ICT, adapted from Technology Proficiency Self-Assessment Questionnaire for 21st Century Learning (TPSA-C-21). RESULTS The evaluation included 26 students who expressed confidence in their Internet/ICT skills They showed enthusiasm for telehealth and recognized its potential benefits, but also emphasized the value of face-to-face interactions. They requested information on legal and aspects and additional learning. Post-test assessments indicated improvements in overall acceptance and use attitudes towards telehealth and on six dimensions of the UTAUT2 instrument. Participation in the course indicated improvements in students' overall acceptance and use attitudes and on six of the ten dimensions of the UTAUT2 instrument (p < 0.05). CONCLUSION This preliminary evaluation indicated that the telehealth course was a positive and enjoyable learning experience for students with appropriate structure and information. The course was successful in improving students' acceptance and use of health technology. The study identified areas in which further development might be required. As such, the course represents a helpful approach for telehealth training among health professions students. Further evaluation with larger samples is required.
Collapse
Affiliation(s)
- Rodrigo J Mariño
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
- Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Daniel Capurro
- Melbourne Faculty of Engineering and IT, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Mark Merolli
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
- Deptartment of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|
3
|
Lek JJ, Cham KM, Merolli M. Evaluating perceived technology self-efficacy and telehealth acceptance in optometry students. Clin Exp Optom 2024:1-12. [PMID: 39097971 DOI: 10.1080/08164622.2024.2380080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/08/2024] [Accepted: 07/10/2024] [Indexed: 08/06/2024] Open
Abstract
CLINICAL RELEVANCE Constant technological improvements require practitioners to be open to adopting technologies such as telehealth for enhanced patient care. Understanding the barriers and facilitators of telehealth adoption will guide stakeholders in making decisions for safe and effective implementation of telehealth. BACKGROUND Effective use of telehealth improves patient outcomes. It is unclear if optometry students feel supported in using and/or are accepting of telehealth. This study evaluated telehealth acceptance of optometry students, its association with their technology self-efficacy, and whether telehealth training alters this relationship. METHODS Final-year optometry students at the University of Melbourne were invited to participate in a telehealth course. A 22-item online survey adapted from the Technology Proficiency Self-Assessment for twenty-first Century Learning was used to evaluate technology self-efficacy pre- and post-learning. Telehealth acceptance was evaluated using a 34-item survey according to the Unified Theory of Acceptance and Use of Technology-2. A 5-point Likert scale was used for each item, yielding two total scores. Respondent demographics, frequency of usage and number of devices were recorded. Descriptive statistics, ANOVA and Pearson correlation were used to analyse demographic variables and relationship between technology self-efficacy and telehealth acceptance. RESULTS 58 (68%) and 49 (58%) students participated in the pre- and post-learning surveys. Majority were 20-29-year-old females. Students used between two and four devices for online activities, with 62% being online at least hourly. Technology self-efficacy scores (average ± SD) pre- and post-learning were 83.8% ± 8.2 and 87.8% ± 7.1. Telehealth acceptance scores pre- and post-learning were 66.1% ± 9.6 and 73.98% ± 9.9. There was no association with gender, number of devices and frequency of online use for all scores. Correlation between technology self-efficacy and telehealth acceptance was insignificant pre-learning (p = 0.3) but was significant post-learning (p = 0.04). CONCLUSION Optometry students demonstrated high technology self-efficacy compared to telehealth acceptance. Telehealth training resulted in marked improvement in telehealth acceptance.
Collapse
Affiliation(s)
- Jia Jia Lek
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kwang Meng Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Merolli
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Dhunnoo P, Kemp B, McGuigan K, Meskó B, O'Rourke V, McCann M. Evaluation of Telemedicine Consultations Using Health Outcomes and User Attitudes and Experiences: Scoping Review. J Med Internet Res 2024; 26:e53266. [PMID: 38980704 PMCID: PMC11267102 DOI: 10.2196/53266] [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] [Received: 10/01/2023] [Revised: 01/27/2024] [Accepted: 03/19/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Despite a recent rise in adoption, telemedicine consultations retention remains challenging, and aspects around the associated experiences and outcomes remain unclear. The need to further investigate these aspects was a motivating factor for conducting this scoping review. OBJECTIVE With a focus on synchronous telemedicine consultations between patients with nonmalignant chronic illnesses and health care professionals (HCPs), this scoping review aimed to gain insights into (1) the available evidence on telemedicine consultations to improve health outcomes for patients, (2) the associated behaviors and attitudes of patients and HCPs, and (3) how supplemental technology can assist in remote consultations. METHODS PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided the scoping review process. Inclusion criteria were (1) involving adults with nonmalignant, noncommunicable chronic conditions as the study population; (2) focusing on health outcomes and experiences of and attitudes toward synchronous telemedicine consultations between patients and HCPs; and (3) conducting empirical research. A search strategy was applied to PubMed (including MEDLINE), CINAHL Complete, APA PsycNet, Web of Science, IEEE, and ACM Digital. Screening of articles and data extraction from included articles were performed in parallel and independently by 2 researchers, who corroborated their findings and resolved any conflicts. RESULTS Overall, 4167 unique articles were identified from the databases searched. Following multilayer filtration, 19 (0.46%) studies fulfilled the inclusion criteria for data extraction. They investigated 6 nonmalignant chronic conditions, namely chronic obstructive pulmonary disease, diabetes, chronic kidney disease, ulcerative colitis, hypertension, and congestive heart failure, and the telemedicine consultation modality varied in each case. Most observed positive health outcomes for patients with chronic conditions using telemedicine consultations. Patients generally favored the modality's convenience, but concerns were highlighted around cost, practical logistics, and thoroughness of clinical examinations. The majority of HCPs were also in favor of the technology, but a minority experienced reduced job satisfaction. Supplemental technological assistance was identified in relation to technical considerations, improved remote workflow, and training in remote care use. CONCLUSIONS For patients with noncommunicable chronic conditions, telemedicine consultations are generally associated with positive health outcomes that are either directly or indirectly related to their ailment, but sustained improvements remain unclear. These modalities also indicate the potential to empower such patients to better manage their condition. HCPs and patients tend to be satisfied with remote care experience, and most are receptive to the modality as an option. Assistance from supplemental technologies mostly resides in addressing technical issues, and additional modules could be integrated to address challenges relevant to patients and HCPs. However, positive outcomes and attitudes toward the modality might not apply to all cases, indicating that telemedicine consultations are more appropriate as options rather than replacements of in-person visits.
Collapse
Affiliation(s)
- Pranavsingh Dhunnoo
- Department of Computing, Atlantic Technological University, Letterkenny, Ireland
- The Medical Futurist Institute, Budapest, Hungary
| | - Bridie Kemp
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | - Karen McGuigan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom
| | | | - Vicky O'Rourke
- Faculty of Business, Atlantic Technological University, Letterkenny, Ireland
| | - Michael McCann
- Department of Computing, Atlantic Technological University, Letterkenny, Ireland
| |
Collapse
|
5
|
Martin T, Veldeman S, Großmann H, Fuchs-Frohnhofen P, Czaplik M, Follmann A. Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study. JMIR Aging 2024; 7:e55471. [PMID: 38842915 PMCID: PMC11190630 DOI: 10.2196/55471] [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] [Received: 12/13/2023] [Revised: 03/14/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. OBJECTIVE This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice. METHODS A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. RESULTS In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. CONCLUSIONS Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine.
Collapse
Affiliation(s)
- Tobias Martin
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Sarah Veldeman
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | | | | | - Michael Czaplik
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Docs In Clouds Telecare GmbH, Aachen, Germany
| | - Andreas Follmann
- Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
6
|
Schiller B, Kuska M, Becher-Urbaniak S, Wimmer E, Reisinger M, Mörtl K. Online psychotherapy as a first clinical experience during the Covid-19 pandemic: A new generation of psychotherapists in the digital age. Heliyon 2024; 10:e29464. [PMID: 38638950 PMCID: PMC11024621 DOI: 10.1016/j.heliyon.2024.e29464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/30/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
The temporary closure of the Outpatient Psychotherapy Clinic at the Sigmund Freud Private University in Vienna during the Covid-19 pandemic demanded an immediate and unexpected reaction to assure further psychotherapeutic services. Both psychotherapists and patients were forced into a rapid transition to online psychotherapy. While Covid-19 research has comprehensively described challenges of online psychotherapies, we were interested in learning specifically how early stage psychotherapists-in-training, who started their clinical work with patients exclusively in the online setting, experienced this unprecedented clinical situation. Sixteen in-depth interviews were conducted with psychotherapists in training. The data were analyzed using a thematic analysis. The analysis revealed how psychotherapists in training were able to cultivate a set of early-training resources and competencies in the online therapy setting without evidence-based guidelines from supervisors and the institution. This study highlighted the necessity of incorporating specific and novel educational input that is necessary for achieving specific online skills in the early training phase. Recognizing that the therapeutic landscape has undergone an irreversible transformation, the data suggest that distinct techniques are necessary to equip early-training psychotherapists for the now commonly practiced alternation between online setting and in-person setting in psychotherapeutic processes.
Collapse
Affiliation(s)
- Birgitta Schiller
- Institute for Qualitative Research, Sigmund Freud Private University Vienna, Austria
| | - Martin Kuska
- Faculty of Psychotherapy Science, Sigmund Freud Private University Vienna, Austria
| | - Stella Becher-Urbaniak
- Research Department University Outpatient Clinic for Adults, Sigmund Freud Private University Vienna, Austria
| | - Eva Wimmer
- Institute for Qualitative Research, Sigmund Freud Private University Vienna, Austria
| | - Manfred Reisinger
- Institute for Qualitative Research, Sigmund Freud Private University Vienna, Austria
| | - Kathrin Mörtl
- Institute for Qualitative Research, Sigmund Freud Private University Vienna, Austria
| |
Collapse
|
7
|
Ting CY, Abdul Halim NH, Ling JN, Tiong IK, Ahmad Shauki NIHJ, Lee YF, Osman NA, Chai GW, Ung SH, Ang M. The use of a multi-disciplinary geriatric telemedicine service (TELEG) and its acceptance at a tertiary care centre in Malaysia. BMC Geriatr 2024; 24:133. [PMID: 38317117 PMCID: PMC10845621 DOI: 10.1186/s12877-024-04676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has fueled the widespread adoption of telemedicine in healthcare, particularly in Sarawak, Malaysia. This study investigates the use and acceptance of Sarawak's inaugural multidisciplinary geriatric telemedicine service, TELEG. METHODS This cross-sectional study took place at the Sarawak Heart Centre's geriatric department from July 1, 2021, to April 30, 2022. Convenient sampling included all TELEG-enrolled patients during this period, to achieve minimum sample size of 148. TELEG's utilization was assessed in terms of medication therapy and treatment plan optimization, as well as enhanced healthcare accessibility. Participants' acceptance of TELEG was measured using the Service User Technology Acceptability Questionnaire (SUTAQ) administered through Google Forms. Descriptive statistics percentages illustrated the proportion of participants who found TELEG moderately to highly acceptable. Associations between baseline characteristics and overall acceptance were explored through bivariate analyses, including Pearson's correlation test, independent t-test, and ANOVA. The influence of six SUTAQ dimensions on overall acceptance, multivariable linear regression using enter method was employed. Statistical significance was determined by p-values less than 0.5. RESULTS Among 180 geriatric patients enrolled in TELEG during the study period, 149 agreed to participate. TELEG led to medication therapy optimization for 88.6% of participants, primarily involving dose adjustment (44.7%), de-prescribing (31.8%), and prescribing (15.9%). Additionally, 53.8% received treatment plan optimization, predominantly in the form of self-care education (56.3%), referrals for further treatment (33.8%), additional laboratory investigations (29.6%), and increased monitoring (26.8%). Among those educated in self-care (n = 40), dietary intake (27.5%), lower limb exercise (25.0%), and COVID-19 vaccination (12.5%) were the most common topics. All participants expressed moderate to high acceptance of TELEG (mean = 4.9, SD = 0.65, on a scale of 1 to 6). Notably, care personnel concern (B = 0.256; p < 0.001) had the most significant impact on overall acceptance. CONCLUSION This pioneering study evaluates the utilization and user acceptance of a geriatric telemedicine service in the region, providing valuable insights to support its expansion. Follow-up surveys or interviews to gain insights into users' experiences are crucial to further enhance acceptance.
Collapse
Affiliation(s)
- Chuo Yew Ting
- Pharmaceutical Services Division, Sarawak State Health Department, Ministry of Health, Jalan Diplomatik, Off Jalan Bako, Kuching, 93350, Malaysia.
| | - Nur Hidayati Abdul Halim
- Institute for Health Systems Research, National Institute of Health, Ministry of Health, Shah Alam, Malaysia
| | - Jia Nee Ling
- Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
| | | | - Nor Izzah H J Ahmad Shauki
- Institute for Health Systems Research, National Institute of Health, Ministry of Health, Shah Alam, Malaysia
| | - Yew Fong Lee
- Sarawak General Hospital, Ministry of Health, Kuching, Malaysia
- School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Nor Anizah Osman
- Pharmaceutical Services Division, Sarawak State Health Department, Ministry of Health, Jalan Diplomatik, Off Jalan Bako, Kuching, 93350, Malaysia
| | - Gin Wei Chai
- Sarawak Heart Centre, Ministry of Health, Kota Samarahan, Malaysia
| | - Shin Han Ung
- Sarawak Heart Centre, Ministry of Health, Kota Samarahan, Malaysia
| | - Melinda Ang
- Sarawak Heart Centre, Ministry of Health, Kota Samarahan, Malaysia
| |
Collapse
|
8
|
Shekunov J, Swintak C, Somers K, Kolla BB, Ruble A, Bhatt-Mackin S, Topor D, Murray A, Romanowicz M. The Virtual Couch: a Curriculum on the Question of the Fundamentals of Remote Psychotherapy-Pilot Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:52-56. [PMID: 37365485 PMCID: PMC10799114 DOI: 10.1007/s40596-023-01805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE With a rise in remote clinical practice related to the COVID-19 pandemic, a novel remote psychotherapy curriculum was presented to psychiatry residents and fellows to address the urgent need to teach trainees how to adapt traditional psychotherapy skills to telepsychiatry settings. METHODS Trainees completed a survey before and after receiving the curriculum to assess remote psychotherapy skills and areas for growth. RESULTS Eighteen trainees (24% fellows, 77% residents) completed the pre-curriculum survey, and 28 trainees (26% fellows, 74% residents) completed the post-curriculum survey. Thirty-five percent of pre-curriculum participants indicated no experience with remote psychotherapy. Technology (24%) and patient engagement (29%) were identified as the greatest challenges in providing teletherapy pre-curriculum. Content related to patient care (69%) and technology (31%) was of most interest to pre-curriculum participants and identified as most helpful post-curriculum (53% and 26%, respectively). After receiving the curriculum, most trainees planned to make internal, provider-related changes to their remote teletherapy practice. CONCLUSIONS The remote psychotherapy curriculum was well received by psychiatry trainees who had limited experience with remote clinical practice prior to the pandemic.
Collapse
Affiliation(s)
| | | | | | | | - Anne Ruble
- Johns Hopkins University, Baltimore, MD, USA
| | | | - David Topor
- VA Boston Healthcare System, Boston, MA, USA
| | | | | |
Collapse
|
9
|
Cummins MR, Soni H, Ivanova J, Ong T, Barrera J, Wilczewski H, Welch B, Bunnell BE. Narrative review of telemedicine applications in decentralized research. J Clin Transl Sci 2024; 8:e30. [PMID: 38384915 PMCID: PMC10880018 DOI: 10.1017/cts.2024.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
Telemedicine enables critical human communication and interaction between researchers and participants in decentralized research studies. There is a need to better understand the overall scope of telemedicine applications in clinical research as the basis for further research. This narrative, nonsystematic review of the literature sought to review and discuss applications of telemedicine, in the form of synchronous videoconferencing, in clinical research. We searched PubMed to identify relevant literature published between January 1, 2013, and June 30, 2023. Two independent screeners assessed titles and abstracts for inclusion, followed by single-reviewer full-text screening, and we organized the literature into core themes through consensus discussion. We screened 1044 publications for inclusion. Forty-eight publications met our inclusion and exclusion criteria. We identified six core themes to serve as the structure for the narrative review: infrastructure and training, recruitment, informed consent, assessment, monitoring, and engagement. Telemedicine applications span all stages of clinical research from initial planning and recruitment to informed consent and data collection. While the evidence base for using telemedicine in clinical research is not well-developed, existing evidence suggests that telemedicine is a potentially powerful tool in clinical research.
Collapse
Affiliation(s)
- Mollie R. Cummins
- University of Utah, College of Nursing, Salt Lake City, UT, USA
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | | | - Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
| | - Janelle Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| | | | - Brandon Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
| |
Collapse
|
10
|
Masters K, Correia R, Nemethy K, Benjamin J, Carver T, MacNeill H. Online learning in health professions education. Part 2: Tools and practical application: AMEE Guide No. 163. MEDICAL TEACHER 2024; 46:18-33. [PMID: 37740948 DOI: 10.1080/0142159x.2023.2259069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Part 1 of the AMEE Guide Online learning in health professions education focused on foundational concepts such as theory, methods, and instructional design in online learning. Part 2 builds upon Part 1, introducing technology tools and applications of these foundational concepts by exploring the various levels (from beginner to advanced) of utilisation, while describing how their usage can transform Health Professions Education. This Part covers Learning Management Systems, infographics, podcasting, videos, websites, social media, online discussion forums, simulation, virtual patients, extended and virtual reality. Intertwined are other topics, such as online small group teaching, game-based learning, FOAM, online social and collaboration learning, and virtual care teaching. We end by discussing digital scholarship and emerging technologies. Combined with Part 1, the overall aim of Part 2 is to produce a comprehensive overview to help guide effective use online learning in Health Professions Education.
Collapse
Affiliation(s)
- Ken Masters
- Medical Education and Informatics Department, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman
| | | | - Kataryna Nemethy
- Baycrest Academy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jennifer Benjamin
- Department of Education Innovation and Technology, Texas Childrens Hospital (TCH), Texas, USA
| | | | - Heather MacNeill
- Department of Medicine, Continuing Professional Development, University of Toronto, Toronto, Canada
| |
Collapse
|
11
|
Scott IA, Shaw T, Slade C, Wan TT, Coorey C, Johnson SLJ, Sullivan CM. Digital health competencies for the next generation of physicians. Intern Med J 2023; 53:1042-1049. [PMID: 37323107 DOI: 10.1111/imj.16122] [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] [Received: 12/13/2022] [Accepted: 04/24/2023] [Indexed: 06/17/2023]
Abstract
As health care continues to change and evolve in a digital society, there is an escalating need for physicians who are skilled and enabled to deliver care using digital health technologies, while remaining able to successfully broker the triadic relationship among patients, computers and themselves. The focus needs to remain firmly on how technology can be leveraged and used to support good medical practice and quality health care, particularly around resolution of longstanding challenges in health care delivery, including equitable access in rural and remote areas, closing the gap on health outcomes and experiences for First Nations peoples and better support in aged care and those living with chronic disease and disability. We propose a set of requisite digital health competencies and recommend that the acquisition and evaluation of these competencies become embedded in physician training curricula and continuing professional development programmes.
Collapse
Affiliation(s)
- Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christine Slade
- Institute for Teaching and Learning Innovation (ITaLI), University of Queensland, Brisbane, Queensland, Australia
| | - Tai T Wan
- Department of Rehabilitation Medicine, Fairfield Hospital, Sydney, New South Wales, Australia
| | - Craig Coorey
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sandra L J Johnson
- Department of Child and Adolescent Health, Children's Hospital, Westmead, Sydney, New South Wales, Australia
| | - Clair M Sullivan
- Queensland Digital Health Centre, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
12
|
Mariño R, Manton D, Reid K, Delany C. Preparedness for dental practice in Australia: a qualitative study on the experiences of final-year students and new graduates. BMC MEDICAL EDUCATION 2023; 23:318. [PMID: 37158908 PMCID: PMC10165283 DOI: 10.1186/s12909-023-04306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Limited data exists regarding the perspectives of newly graduated dental practitioners (NGDPs) and final-year students (FYS) about their preparedness for dental practice. This information is crucial to inform developments in ongoing professional development for newly qualified dental practitioners and future reviews and development of accreditation standards, policies, and the professional competencies of newly qualified dental practitioners. Thus, the primary goal of this paper was to describe the perceptions of preparedness for dental practice of NGDPs and FYSs. METHODS Individual semi-structured interviews were conducted between March and July 2020. All interviews were audiotaped, transcribed, and analysed using a thematic analysis. RESULTS Eighteen NGDPs and four FYS from across Australia participated in the qualitative interviews. A strong theme from the data was that respondents believed they were well prepared for common challenges in dental practice and patient care. A second prominent theme was participants' awareness of specific areas of limitation in their knowledge and specific skills including (list them). This data highlights a high level of self-awareness and potential for self-directed learning of NGDPs. It also provides specific content areas for future curriculum developers. CONCLUSIONS Newly graduated dental practitioner and final-year student participants were satisfied with the theoretical and evidence-based information in their formal learning and teaching activities to begin practicing as dental practitioners. In some areas, NGDPs felt underprepared, mostly attributed to limited clinical treatment exposure, and other contextual elements of clinical practice, and thought transitional support may be required. The research reinforces the value of seeking and learning from students' and NGDPs' perspectives.
Collapse
Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia.
- Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile.
| | - David Manton
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
- University of Groningen, UMCG, Centre for Dentistry and Oral Hygiene, Groningen, The Netherlands
| | - Katharine Reid
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Clare Delany
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| |
Collapse
|
13
|
Bajra R, Frazier W, Graves L, Jacobson K, Rodriguez A, Theobald M, Lin S. Feasibility and Acceptability of a US National Telemedicine Curriculum for Medical Students and Residents: Multi-institutional Cross-sectional Study. JMIR MEDICAL EDUCATION 2023; 9:e43190. [PMID: 37155241 DOI: 10.2196/43190] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/10/2023] [Accepted: 03/31/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Telemedicine use increased as a response to health care delivery changes necessitated by the COVID-19 pandemic. However, lack of standardized curricular content creates gaps and inconsistencies in effectively integrating telemedicine training at both the undergraduate medical education and graduate medical education levels. OBJECTIVE This study evaluated the feasibility and acceptability of a web-based national telemedicine curriculum developed by the Society of Teachers of Family Medicine for medical students and family medicine (FM) residents. Based on the Association of American Medical Colleges telehealth competencies, the asynchronous curriculum featured 5 self-paced modules; covered topics include evidence-based telehealth uses, best practices in communication and remote physical examinations, technology requirements and documentation, access and equity in telehealth delivery, and the promise and potential perils of emerging technologies. METHODS A total of 17 medical schools and 17 FM residency programs implemented the curriculum between September 1 and December 31, 2021. Participating sites represented 25 states in all 4 US census regions with balanced urban, suburban, and rural settings. A total of 1203 learners, including 844 (70%) medical students and 359 (30%) FM residents, participated. Outcomes were measured through self-reported 5-point Likert scale responses. RESULTS A total of 92% (1101/1203) of learners completed the entire curriculum. Across the modules, 78% (SD 3%) of participants agreed or strongly agreed that they gained new knowledge, skills, or attitudes that will help them in their training or career; 87% (SD 4%) reported that the information presented was at the right level for them; 80% (SD 2%) reported that the structure of the modules was effective; and 78% (SD 3%) agreed or strongly agreed that they were satisfied. Overall experience using the national telemedicine curriculum did not differ significantly between medical students and FM residents on binary analysis. No consistent statistically significant relationships were found between participants' responses and their institution's geographic region, setting, or previous experience with a telemedicine curriculum. CONCLUSIONS Both undergraduate medical education and graduate medical education learners, represented by diverse geographic regions and institutions, indicated that the curriculum was broadly acceptable and effective.
Collapse
Affiliation(s)
- Rika Bajra
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Winfred Frazier
- St. Margaret Family Medicine Residency Program, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Lisa Graves
- Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Katherine Jacobson
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Andres Rodriguez
- Division of Family and Community Medicine, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine, Miami, FL, United States
| | - Mary Theobald
- Society of Teachers of Family Medicine, Leawood, KS, United States
| | - Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| |
Collapse
|
14
|
Kumra T, Amundsen DB, Mullins A, Hindman DJ, Hughes HK, Pahwa AK. Telehealth Curricula in the Pediatric Core Clerkship: Results From a Survey of Clerkship Directors. Cureus 2023; 15:e39200. [PMID: 37337508 PMCID: PMC10276772 DOI: 10.7759/cureus.39200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Given the increasing prevalence of telehealth, medical students require dedicated instruction in the practice of high-quality telehealth. This study characterizes telehealth practices and curricula in pediatric core clerkships across the United States and Canada. METHODS We surveyed pediatric core clerkship directors and site directors through the 2020 Council on Medical Student Education in Pediatrics (COMSEP) annual member survey. We analyzed the results using descriptive statistics. RESULTS Of 104 medical schools represented, 28 responded (26.9%). Directors reported students spent little time on telehealth during their pediatric core clerkships (average 8.2% of clerkship; SD 10.4). Only 10.7% (n=3) of clerkships had dedicated telehealth curricula. The instructional methods, content, and modes of evaluation varied across the clerkships' curricula. Barriers to implementation of telehealth curricula included lack of dedicated time in the existing curriculum (64.0%), lack of faculty time to teach (44.0%), lack of curricular materials (44.0%), students not participating in telehealth activities (40.0%) and lack of faculty expertise (36.0%). CONCLUSIONS Most pediatric core clerkships do not include dedicated telehealth curricula, and the characteristics of existing curricula vary. Considering the rapid adoption of telemedicine, pediatric core clerkships merit additional support and guidance for the training of medical students in telehealth practice.
Collapse
Affiliation(s)
- Tina Kumra
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Danielle B Amundsen
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alexa Mullins
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Daniel J Hindman
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Helen K Hughes
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Amit K Pahwa
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
15
|
Palesy D, Forrest G, Crowley ME. Education guidelines, frameworks and resources for building virtual care capacity: An integrative review. J Telemed Telecare 2023; 29:222-243. [PMID: 36628539 DOI: 10.1177/1357633x221149230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Despite its reported benefits, the accelerated adoption of virtual care since the COVID-19 pandemic has occurred without critical consideration of clinician education and training. This integrative review aims to better understand the necessary education guidelines, frameworks and resources for building the confidence and capability of the workforce for virtual care delivery. METHODS Whittemore and Knafl's (2005) five-stage methodological framework informed this review. Using a clearly articulated search strategy and reporting process, over 8000 pieces of literature were analysed. A final 46 publications comprising 26 scholarly papers and 20 pieces of grey literature were included for review. RESULTS A set of key curriculum inclusions under three domains: clinical, administrative and technical are proposed. Many publications emphasise a domain-specific approach as the most effective means of translating virtual care knowledge and skills to practice. A number of new domain frameworks have been tailormade for specific disciplines, while well-established frameworks such as the ACGME, CanMEDS, AAMC and IPEC have been adapted for virtual care education. Virtual care checklists, clinical champions and models that involve frontline clinicians, content experts and care recipients are considered useful resources for virtual care education. DISCUSSION Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a cohesive, interprofessional approach. This approach should be rigorously evaluated as part of a continuous quality improvement process.
Collapse
Affiliation(s)
- Debra Palesy
- Sessional Academic, University of Technology Sydney, NSW, Australia
| | - Gail Forrest
- Senior Manager Clinical Education Strategy, Research and Evaluation, Health Education and Training Institute, NSW Health, St Leonards, NSW, Australia
| | - Margaret E Crowley
- Director, Professional Practice & Interprofessional Collaboration Portfolio, Health Education and Training Institute, NSW Health, St Leonards, NSW, Australia
| |
Collapse
|
16
|
Ahmed Kamal M, Ismail Z, Shehata IM, Djirar S, Talbot NC, Ahmadzadeh S, Shekoohi S, Cornett EM, Fox CJ, Kaye AD. Telemedicine, E-Health, and Multi-Agent Systems for Chronic Pain Management. Clin Pract 2023; 13:470-482. [PMID: 36961067 PMCID: PMC10037594 DOI: 10.3390/clinpract13020042] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023] Open
Abstract
Telemedicine, telehealth, and E-health all offer significant benefits for pain management and healthcare services by fostering the physician-patient relationship in otherwise challenging circumstances. A critical component of these artificial-intelligence-based health systems is the "agent-based system", which is rapidly evolving as a means of resolving complicated or straightforward problems. Multi-Agent Systems (MAS) are well-established modeling and problem-solving modalities that model and solve real-world problems. MAS's core concept is to foster communication and cooperation among agents, which are broadly considered intelligent autonomous factors, to address diverse challenges. MAS are used in various telecommunications applications, including the internet, robotics, healthcare, and medicine. Furthermore, MAS and information technology are utilized to enhance patient-centered palliative care. While telemedicine, E-health, and MAS all play critical roles in managing chronic pain, the published research on their use in treating chronic pain is currently limited. This paper discusses why telemedicine, E-health, and MAS are the most critical novel technologies for providing healthcare and managing chronic pain. This review also provides context for identifying the advantages and disadvantages of each application's features, which may serve as a useful tool for researchers.
Collapse
Affiliation(s)
| | - Zainab Ismail
- Faculty of Medicine, Menoufia University, Shiben El Kom 51123, Egypt
| | - Islam Mohammad Shehata
- Department of Anesthesiology, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt
| | - Soumia Djirar
- Department of Ophthalmology, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Norris C Talbot
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Charles J Fox
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| |
Collapse
|
17
|
Stovel RG, Dubois D, Chan TM, Thoma B, Ho K. Virtual Care in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:22-26. [PMID: 36998491 PMCID: PMC10042775 DOI: 10.36834/cmej.75439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Daniel Dubois
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ontario, Canada
| | - Teresa M Chan
- Office of Continuing Professional Development, Faculty of Health Sciences, McMaster University, Ontario, Canada
| | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
| | - Kendall Ho
- Department of Emergency Medicine, UBC Faculty of Medicine, British Columbia, Canada
| |
Collapse
|
18
|
García-Gutiérrez FM, Pino-Zavaleta F, Romero-Robles MA, Patiño-Villena AF, Jauregui-Cornejo AS, Benites-Bullón A, Goméz-Mendoza A, Alarcon-Ruiz CA, Huapaya-Huertas O. Self-reported perceptions and knowledge of telemedicine in medical students and professionals who enrolled in an online course in Peru. BMC MEDICAL EDUCATION 2023; 23:88. [PMID: 36737732 PMCID: PMC9896674 DOI: 10.1186/s12909-023-04058-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/24/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Telemedicine has become more relevant during the COVID-19 pandemic. However, medical students and professionals do not acquire competences in telemedicine during their training. Our objective was to describe the self-reported perception and baseline knowledge of telemedicine among medical students and professionals enrolled in a virtual course. METHODS Cross-sectional study that included physicians or medical students aged 18 years or older who were interested in a free virtual telemedicine course and who completed the data collection questionnaire. We used a Likert scale to assess the self-reported perceptions of four domains related to telemedicine. The participants were grouped into three levels for each domain: low, medium and high. We also objectively assessed telemedicine knowledge by means of 10 questions, with a cut-off point of 50% of correct answers. The Fisher's exact test, the Chi-square test, and the Mann-Whitney U test were used for the comparison of categorical data. A p-value < 0.05 was considered statistically significant. RESULTS We included 161 participants: 118 medical students and 43 physicians. We observed no significant differences between medical students and physicians in self-reported perceptions of knowledge, security, or utility of telemedicine. However, students had a high self-reported perception of the disadvantages of telemedicine especially related to patient security (p = 0.018), efficiency of care (p = 0.040), and the possibility of medical malpractice (p = 0.010) compared to physicians. Nearly half of the students (n = 53,44.9%) and physicians (n = 22,51.7%) answered 50% or more of the questions related to telemedicine knowledge correctly. CONCLUSION Among the physicians and medical students enrolled in the course, the students perceived the disadvantages of telemedicine more frequently. Although physicians and students have limited knowledge of telemedicine, there appears to be no influence of experience and prior training in telemedicine.
Collapse
Affiliation(s)
- Fabrizio M García-Gutiérrez
- Sociedad Científica de Estudiantes de Medicina de La Universidad Nacional de Trujillo, Trujillo, Perú
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
| | - Francis Pino-Zavaleta
- Sociedad Científica de Estudiantes de Medicina de La Universidad Nacional de Trujillo, Trujillo, Perú
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
| | | | | | - Abigail S Jauregui-Cornejo
- Comité Permanente Académico, Sociedad Científica Médico Estudiantil Peruana, Lima, Perú
- Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, 15067, Perú
| | | | | | - Christoper A Alarcon-Ruiz
- Unidad de Investigación Para La Generación Y Síntesis de Evidencia en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | | |
Collapse
|
19
|
Shepherd L, McConnell A, Watling C. Good for patients but not learners? Exploring faculty and learner virtual care integration. MEDICAL EDUCATION 2022; 56:1174-1183. [PMID: 35732194 DOI: 10.1111/medu.14861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The pandemic catapulted the adoption of virtual care far ahead of its anticipated maturation date, forcing faculty to role model and teach learners with barely enough time to master it themselves. With a scant body of prepandemic literature now accompanied by experience gained under extraordinary circumstances, we can benefit from understanding ad hoc strategies implemented by those on the front lines and from listening to learners about what is working and what is not. The purpose of this study was to explore the experience of learner integration into virtual care from both the faculty and learner perspectives. METHODS Using a constructivist grounded theory methodology and sociomateriality as a sensitising concept, we recruited participants using purposeful and theoretical sampling from a Canadian University with limited prepandemic virtual care provision. We interviewed 16 faculty and 5 learners spanning a breadth of specialties and years of practice/education to probe their experience of teaching and learning virtual care. Data collection and analysis were conducted iteratively with themes identified through constant comparative analysis. RESULTS Integrating learners into virtual care proved challenging initially because of a lack of familiarity with the process and later because of disrupted workflow, triggered by the structure and logistics of the virtual care clinic. Both faculty and learners identified learning deficiencies in the virtual care experience when compared with in-person clinics, but several unique and valuable learning affordances were noted. All faculty expressed a desire to keep virtual care as part of their future clinic practice, but paradoxically most felt that they were unlikely to include learners. CONCLUSIONS Training learners in virtual care is an educational challenge that will not disappear with COVID-19, even if our participants wished it could. The perceived value for patients but not learners begs a reconsideration of the sociomaterial contribution to this pandemic paradox.
Collapse
Affiliation(s)
- Lisa Shepherd
- Centre for Education Research & Innovation, Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Allison McConnell
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christopher Watling
- Department of Oncology and Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| |
Collapse
|
20
|
Hoffman B, Braund H, McKeown S, Dalgarno N, Godfrey C, Appireddy R. Telemedicine and medical education: a mixed methods systematic review protocol. JBI Evid Synth 2022; 20:3045-3057. [PMID: 35946805 DOI: 10.11124/jbies-21-00481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to synthesize and appraise the available research on educational strategies required to prepare medical learners for engaging in telemedicine and virtual care. INTRODUCTION The COVID-19 pandemic has resulted in significant uptake of virtual care and telemedicine, highlighting the growing need for health care organizations and medical institutions to support physicians and learners navigating this new model of health care delivery, clinical learning, and assessment. Developing a better understanding of how best to prepare medical trainees across the continuum of undergraduate, postgraduate, and continuing professional development to engage in virtual care is critical in ensuring our continued ability to meet educational mandates and provide ambulatory care that is safe, efficient, and timely. INCLUSION CRITERIA Eligible studies will include medical learners who receive education on how to deliver telemedicine. The quantitative component of the review will compare learners exposed to educational interventions with learners not exposed to an intervention, or to a different intervention. Outcomes will include competencies in telemedicine delivery, knowledge, and behaviors. The qualitative component of the review will explore learners' experiences with the delivery of educational strategies that address telemedicine. METHODS Embase, MEDLINE, Evidence-Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Education Source, and ProQuest Dissertations and Theses Global will be searched to identify published and unpublished studies. No date or language restrictions will be applied. This systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews using a convergent segregated approach. Titles and abstracts of potential studies will be screened, and potentially relevant studies will undergo full-text review for eligibility and critical appraisal of the study methodology. Data will be extracted from those studies selected for inclusion. Findings will be described relating to the effectiveness of educational curricula, initiatives, and best practices in trainee engagement in telemedicine and virtual care. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021264332.
Collapse
Affiliation(s)
- Bryn Hoffman
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sandra McKeown
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Christina Godfrey
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Faculty of Health Sciences, Queen's University; Division of Neurology, Department of Medicine, School of Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
21
|
Belakovskiy A, Jones EK, Murphy CN, Kelley S, Gallagher K, Furst W, Furgal A, Heidelbaugh J. Socially Distanced Teaching: Faculty Feedback on Teaching During Telemedicine. MEDICAL SCIENCE EDUCATOR 2022; 32:1305-1307. [PMID: 36415500 PMCID: PMC9673886 DOI: 10.1007/s40670-022-01685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The purpose of our study was to evaluate the perceptions of clinical faculty while working with medical students in a novel setting of virtual care following the COVID-19 pandemic. ACTIVITY A survey of faculty, fellows, and residents was conducted to assess educators' perceptions of virtual teaching before trying it and after 3 months of experience. RESULTS Perceived effectiveness of teaching students acute care significantly improved as did perceived effectiveness of teaching chronic care. DISCUSSION We anticipate that continued experience and comfort with virtual platforms would boost this perception further, allowing faculty development to be honed for optimal teaching in this new paradigm. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01685-9.
Collapse
Affiliation(s)
- Aleksandr Belakovskiy
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Elizabeth K. Jones
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Christina Nisonger Murphy
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Scott Kelley
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Kristina Gallagher
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Wendy Furst
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| | - Allison Furgal
- Biostatistics Department, School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Joel Heidelbaugh
- Department of Family Medicine, School of Medicine, Michigan Medicine, 7300 Dexter-Ann Arbor Road, Dexter, Ann Arbor, MI USA
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Digital health technology-specific risks for medical malpractice liability. NPJ Digit Med 2022; 5:157. [PMID: 36261469 PMCID: PMC9581762 DOI: 10.1038/s41746-022-00698-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/29/2022] [Indexed: 11/08/2022] Open
Abstract
Medical professionals are increasingly required to use digital technologies as part of care delivery and this may represent a risk for medical error and subsequent malpractice liability. For example, if there is a medical error, should the error be attributed to the clinician or the artificial intelligence-based clinical decision-making system? In this article, we identify and discuss digital health technology-specific risks for malpractice liability and offer practical advice for the mitigation of malpractice risk.
Collapse
|
24
|
Palesy D, Forrest G, Crowley ME. Curriculum Interventions and Pedagogical Approaches for Virtual Care Delivery: A Scoping Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221105865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The onset of the COVID-19 pandemic has accelerated the adoption of virtual care as a modality for home-based care delivery to individuals and cohorts who might not otherwise have access. While a number of positive outcomes have been reported, rapid growth has occurred without critical consideration of clinician education and training. Little is known about the curricular and pedagogical requirements for educating current and future clinicians in virtual care provision. This review was informed by Arksey and O’Malley’s five-stage methodological framework for scoping reviews, first published in 2005. Using a clearly articulated search strategy and reporting process, over 4000 pieces of literature were analysed to inform this review. A final 17 papers were included. Common themes emerging in relation to curricula content include the basics of virtual care, cultural awareness, interprofessional collaboration/training, telepresence, encompassing non-verbal, verbal and environmental considerations, and virtual care clinical skills. Standalone modules are recommended for delivering ‘the basics’ of virtual care, while the interactive/participative approach is endorsed as an appropriate method of instruction. The reviewed literature reviewed offers a set of core inclusions and pedagogical approaches for a virtual care education program, although these are often mentioned in general terms and are not always well described. Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a consistent and cohesive approach to curricula and pedagogies. These approaches should be rigorously evaluated as part of a continuous quality improvement process.
Collapse
Affiliation(s)
| | - Gail Forrest
- Health Education and Training Institute, NSW Health, St Leonards, NSW Australia
| | - Margaret E. Crowley
- Health Education and Training Institute, NSW Health, St Leonards, NSW Australia
| |
Collapse
|
25
|
Downie A, Mashanya T, Chipwaza B, Griffiths F, Harris B, Kalolo A, Ndegese S, Sturt J, De Valliere N, Pemba S. Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic. JMIR Form Res 2022; 6:e32964. [PMID: 35507772 PMCID: PMC9200055 DOI: 10.2196/32964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.
Collapse
Affiliation(s)
- Andrew Downie
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Titus Mashanya
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Beatrice Chipwaza
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Albino Kalolo
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Sylvester Ndegese
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Nicole De Valliere
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Senga Pemba
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| |
Collapse
|
26
|
Talking Points: Enhancing Communication Between Radiologists and Patients. Acad Radiol 2022; 29:888-896. [PMID: 33846062 DOI: 10.1016/j.acra.2021.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/23/2022]
Abstract
Radiologists communicate along multiple pathways, using written, verbal, and non-verbal means. Radiology trainees must gain skills in all forms of communication, with attention to developing effective professional communication in all forms. This manuscript reviews evidence-based strategies for enhancing effective communication between radiologists and patients through direct communication, written means and enhanced reporting. We highlight patient-centered communication efforts, available evidence, and opportunities to engage learners and enhance training and simulation efforts that improve communication with patients at all levels of clinical care.
Collapse
|
27
|
Venditti SA, Sazegar P, Fuchs LC, Snarskis CE. Family Medicine Resident and Faculty Perceptions About the Strengths and Limitations of Telemedicine Training. PRIMER (LEAWOOD, KAN.) 2022; 6:9. [PMID: 35481229 PMCID: PMC9037250 DOI: 10.22454/primer.2022.665996] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Telemedicine has become a highly-utilized form of primary care, requiring medical schools and residency programs to develop standardized telemedicine training to meet learners' educational needs. This study highlights specific areas of clinical teaching and faculty development regarded as highly valuable in a family medicine (FM) residency program. METHODS We developed a needs assessment survey instrument based on Accreditation Council for Graduate Medical Education (ACGME) milestones and circulated it to faculty and residents at a suburban FM residency program in August 2020. We mapped each survey question to ACGME core competencies to identify common themes. We performed two-sample t tests to compare perceived self-confidence in faculty assessment and resident performance of key telemedicine clinical skills. RESULTS A total of 29 respondents (15 faculty, 14 residents) completed the survey. Both residents and faculty expressed comfort with obtaining a focused history, ruling out red flag symptoms, formulating a differential diagnosis, and planning follow-up care. Faculty reported confidence in their ability to provide feedback about medical knowledge and clinical decision making, but also identified a need for better feedback tools. Both faculty and residents identified a need for better teaching of physical exam skills during video visits. There were no statistically significant differences for perceived self-confidence in evaluating and performing key telemedicine skills between faculty and residents, respectively. CONCLUSION Development of effective telemedicine educational experiences should emphasize teaching virtual communication and physical exam skills, and developing new approaches to learner evaluation.
Collapse
Affiliation(s)
- Sarah A Venditti
- Kaiser Permanente San Diego Family Medicine Residency Program, San Diego, CA
| | - Payam Sazegar
- Kaiser Permanente San Diego Family Medicine Residency Program, San Diego, CA | Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Lance C Fuchs
- Kaiser Permanente San Diego Family Medicine Residency Program, San Diego, CA | Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Carolyn E Snarskis
- Kaiser Permanente San Diego Family Medicine Residency Program, San Diego, CA
| |
Collapse
|
28
|
Heo S, Moon S, Kim M, Park M, Cha WC, Son MH. Setting-up Of A Mechanical Ventilator With An Augmented Reality Guide: A Prospective, Randomized Pilot Trial (Preprint). JMIR Serious Games 2022; 10:e38433. [PMID: 35867382 PMCID: PMC9356328 DOI: 10.2196/38433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/01/2022] [Accepted: 06/12/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Sejin Heo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Suhyeon Moon
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Minha Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Minsu Park
- Department of Information and Statistics, Chungnam National University, Daejeon, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Meong Hi Son
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
29
|
Jeffries PR, Bushardt RL, DuBose-Morris R, Hood C, Kardong-Edgren S, Pintz C, Posey L, Sikka N. The Role of Technology in Health Professions Education During the COVID-19 Pandemic. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S104-S109. [PMID: 34789662 PMCID: PMC8855755 DOI: 10.1097/acm.0000000000004523] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Before the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward.
Collapse
Affiliation(s)
- Pamela R. Jeffries
- P.R. Jeffries is professor and dean, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Reamer L. Bushardt
- R.L. Bushardt is professor and senior associate dean, School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Ragan DuBose-Morris
- R. DuBose-Morris is associate professor, Academic Affairs Faculty, Medical University of South Carolina, Charleston, South Carolina
| | - Colton Hood
- C. Hood is assistant professor, Department of Emergency Medicine, The George Washington University, Washington, DC
| | - Suzan Kardong-Edgren
- S. Kardong-Edgren is associate professor, Department of Health Professions Education, MGH Institute of Health Professions, Boston, Massachusetts
| | - Christine Pintz
- C. Pintz is professor, School of Nursing, The George Washington University, Washington, DC
| | - Laurie Posey
- L. Posey is associate professor, School of Nursing, The George Washington University, Washington, DC
| | - Neal Sikka
- N. Sikka is professor, Department of Emergency Medicine, The GW Medical Faculty Associates, Washington, DC
| |
Collapse
|
30
|
Anderson HL, Kurtz J, West DC, Balmer DF. Replace, amplify, transform: a qualitative study of how postgraduate trainees and supervisors experience and use telehealth for instruction in ambulatory patient care. BMC MEDICAL EDUCATION 2022; 22:118. [PMID: 35193579 PMCID: PMC8861601 DOI: 10.1186/s12909-022-03175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Little is known about using telehealth patient visits as an educational mode. Therefore, rapid implementation of telehealth during the COVID-19 pandemic had to be done without understanding how to optimize telehealth for education. With the likely sustained/post-pandemic use of telehealth in ambulatory patient care, filling gaps in our understanding of how telehealth can be used for instruction in this context is critical. This study sought to understand perceptions of pediatric postgraduate trainees and supervisors on the use of telehealth for instruction in ambulatory settings with the goal of identifying effective ways to enhance learning during telehealth visits. METHODS In May-June of 2020, the authors purposefully sampled first- and third-year postgraduate trainees and supervising attendings from pediatric fellowship programs at one institution that implemented telehealth for instructional activities. They conducted semi-structured interviews; interviews lasted a median of 51 min (trainees) and 41 min (supervisors). They conducted interviews and data analysis iteratively until reaching saturation. Using thematic analysis, they created codes and constructed themes from coded data. They organized themes using the Replace-Amplify-Transform (RAT) model, which proposes that technology can replace in-person learning and/or amplify and transform learning. RESULTS First-year trainees (n = 6), third-year trainees (n = 5) and supervisors (n = 6) initially used telehealth to replace in-person learning. However, skills that could be practiced in telehealth visits differed from in-person visits and instructional activities felt rushed or awkward. Trainees and supervisors adapted and used telehealth to amplify learning by enhancing observation and autonomy. They also transformed learning, using telehealth to develop novel skills. CONCLUSIONS To harness telehealth for instructional activities, our findings indicated that trainees and supervisors should shift from using it as a direct replacement for in-person education to taking advantage of novel opportunities to amplify and transform education in PGME. The authors provide data-driven recommendations to help PGME trainees, supervisors and educators capitalize on the educational advantages of telehealth.
Collapse
Affiliation(s)
- Hannah L Anderson
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 9 NW 76, Philadelphia, PA, 19104, USA.
| | - Joshua Kurtz
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 9 NW 76, Philadelphia, PA, 19104, USA
| | - Daniel C West
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 9 NW 76, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Dorene F Balmer
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd. 9 NW 76, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
31
|
A narrative review exploring the professional practice training requirement of therapeutic radiographers undertaking effective remote/telephone review clinics in place of face-to-face radiographer-led review clinics during the COVID-19 pandemic. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background and purpose:
The COVID-19 pandemic has led to the introduction of alternative on-treatment and post-treatment radiographer-led review clinics in an attempt to protect patients, staff and the public. Pre-COVID, patient reviews were routinely undertaken face-to-face, led by therapeutic review radiographers with advanced practice qualifications and skills in radiotherapy symptom management, triage, referral and support services. During the COVID-19 pandemic, an alternative option has been to follow-up in the form of telephone reviews to reduce face-to-face exposure whilst continuing to manage patient radiotherapy treatment-related toxicities. The aim of the narrative review is to explore the subject of telephone reviews and how therapeutic review radiographers might need to adapt communication skills so that they can continue to effectively assess and manage radiotherapy patient treatment reactions remotely.
Method and discussion:
A narrative review was conducted using the SCOPUS database and 28 publications were included from 2013 to 2021. The review highlights a paucity of literature exploring specific telephone training for radiographers and other allied healthcare professionals. Experiences within medical and nursing programmes demonstrate that development and integration of training in this area is critical in preparing for patient interaction via telephone.
Conclusion and implications for practice:
Multiple teaching modalities including simulation are ideal for teaching telephone-specific skills and content, demonstrating improvement in student knowledge, competence and confidence. Less is known regarding whether this knowledge translates to an improved patient experience. Enhancements in education and training, guided by the Health and Care Professions Council, may be warranted to ensure that patients continue to receive the optimal quality of care in a world where remote reviews are likely to become commonplace. Patient-reported outcome measures might be utilized for future training evaluations to ensure that effective patient care is being maintained.
Collapse
|
32
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Adam Kilian
- The George Washington University, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | - Emily Sirotich
- Canadian Arthritis Patient Alliance, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Stavrou M, Lioutas E, Lioutas J, Davenport RJ. Experiences of remote consulting for patients and neurologists during the COVID-19 pandemic in Scotland. BMJ Neurol Open 2021; 3:e000173. [PMID: 34806013 PMCID: PMC8593270 DOI: 10.1136/bmjno-2021-000173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Remote consulting is an emerging model in managing chronic neurological conditions and has been widely implemented during the COVID-19 pandemic. The objective of this national survey was to investigate the initial experiences of remote consulting for neurologists and patients with established neurological conditions under follow-up during the first COVID-19 phase. METHODS In collaboration with the Scottish Association of Neurological Sciences and the Neurological Alliance of Scotland, we conducted a web-based survey of neurologists and patients between October and November 2020. FINDINGS Data was available for 62 neurologists and 201 patients. The consensus among neurologists was that remote consulting is a satisfactory way of delivering healthcare in selected groups of patients. For practical and technical reasons, there was preference for phone over video consultations (phone 63% vs video 33%, p=0.003). The prevailing opinion among clinicians was that considerable training interventions for remote consultation skills are required ('yes' 63% vs 'no' 37%, p=0.009) to improve clinician consultation skills and successfully embed this new model of care.Most patients perceived remote consultations as safe, effective and convenient, with 89% of patients being satisfied with their remote consultation experience. Although traditional face-to-face consultations were the favoured way of interaction for 62% of patients, a significant proportion preferred that some of their future consultations be remote. INTERPRETATION Although not a replacement for face-to-face consultations, this survey illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations for doctors and patients. More research is required to identify overall safety and applicability.
Collapse
Affiliation(s)
- Maria Stavrou
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK
| | | | | | - Richard J Davenport
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK
| |
Collapse
|
34
|
Cherba M, Grosjean S, Bonneville L, Nahon-Serfaty I, Boileau J, Waldolf R. The essential role of nurses in supporting physical examination in telemedicine: Insights from an interaction analysis of postsurgical consultations in orthopedics. Nurs Inq 2021; 29:e12452. [PMID: 34428319 DOI: 10.1111/nin.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 12/28/2022]
Abstract
Telemedicine changes clinical practice and introduces new ways of distributing tasks between physicians and nurses, and particularly the delegation of sensory assessments during remote physical examinations. As nurses become more involved in patient assessment and clinical decision-making, the quality of physician-nurse collaboration has been recognized as essential to ensure quality patient care. However, few studies have examined physician-nurse interactions during teleconsultations. This article presents the results of an empirical study of nurse-physician communication during remote physical examinations. In partnership with a university-affiliated hospital in Ontario, Canada, we observed and recorded 10 simulated postsurgical consultations in orthopedics (involving a physician, a patient, and an on-site nurse) and conducted auto-confrontation interviews with physicians. The results of the thematic analysis of the interviews informed the selection of consultation sequences for in-depth interaction analysis. The findings demonstrate the nurse's essential role during remote physical examinations and reveal specific practices accomplished by the nurse to ensure successful nurse-physician collaboration. The interview data shows how physicians view the nurse's role and contributions. The findings contribute to our understanding of the collaborative nature of sensory assessments during remote physical examinations in telemedicine and can inform the development of training programs for professionals focusing on communication skills. Implications for clinical practice are discussed.
Collapse
Affiliation(s)
- Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvie Grosjean
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Luc Bonneville
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Isaac Nahon-Serfaty
- Department of Communication, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Judith Boileau
- Department of Clinical Services, Hôpital Montfort, Ottawa, Ontario, Canada
| | - Richard Waldolf
- Institut du Savoir Montfort, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
35
|
Cornes S, Gelfand JM, Calton B. Foundational Telemedicine Workshop for First-Year Medical Students Developed During a Pandemic. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11171. [PMID: 34337148 PMCID: PMC8282677 DOI: 10.15766/mep_2374-8265.11171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In response to the COVID-19 pandemic and the need for social distancing, medical education curricula across the country had to be quickly transitioned from in-person experiences to remote sessions. Simultaneously, use of telemedicine in clinical practice skyrocketed. Despite telemedicine expansion and the opportunity afforded to teach these skills virtually, many institutions lacked telemedicine curricula. METHODS We developed and evaluated a foundational telemedicine workshop during a pandemic (158 students in 28 groups) guided by principles to maximize learner engagement during remote learning, including use of discrete, time-limited activities (self-assessment, templated group exercises, review of brief multimedia, and active role-play.). RESULTS Students completed pre- and postsession surveys to assess session impact. Of 158 students, 92 (58%) completed the presession survey, and 36 (23%) completed the postsession survey. There was an increase in confidence in all areas, particularly in skills related to starting the encounter, minimizing barriers, and taking the medical history. Learners reported the physical examination content as more useful than any other area and valued the exemplar videos provided. DISCUSSION The pandemic highlighted our own institution's need to develop telemedicine curricula to prepare medical students to provide this increasingly essential service. We developed a foundational telemedicine skills session that increased students' reported confidence in their telemedicine knowledge and skills. The session could be easily adapted by other schools interested in incorporating telemedicine into their preclerkship curriculum. Additional experiences providing opportunities to practice and receive feedback on telemedicine skills with standardized and real patients are warranted.
Collapse
Affiliation(s)
- Susannah Cornes
- Associate Professor, Department of Neurology, University of California, San Francisco, School of Medicine
| | - Jeffrey M. Gelfand
- Associate Professor, Department of Neurology, University of California, San Francisco, School of Medicine
| | - Brook Calton
- Associate Professor, Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, School of Medicine
| |
Collapse
|
36
|
Roth LT, Costich M, Moerdler S, Lane M, Robbins-Milne L, Bracho-Sanchez E, Friedman S. Can you hear me now? A toolkit for telemedicine training. CLINICAL TEACHER 2021; 18:348-353. [PMID: 34114346 DOI: 10.1111/tct.13390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lauren T Roth
- Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marguerite Costich
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Scott Moerdler
- Department of Pediatrics (Pediatric Hematology Oncology), Rutgers Cancer Institute of New Jersey/Rutgers Robert Woot Johnson Medical School, New Brunswick, NJ, USA
| | - Mariellen Lane
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Laura Robbins-Milne
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Edith Bracho-Sanchez
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Suzanne Friedman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
37
|
Telemedicine curriculum in undergraduate medical education: a systematic search and review. HEALTH AND TECHNOLOGY 2021; 11:773-781. [PMID: 33996380 PMCID: PMC8109844 DOI: 10.1007/s12553-021-00559-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/05/2021] [Indexed: 12/30/2022]
Abstract
The number of patient-doctor appointments carried out using telemedicine has surpassed in-person appointments. In spite of this, it is unclear that telemedicine curricula in undergraduate medical education reflect the real importance by means of the effectiveness of these approaches. We aimed to systematically search and review the studies that are on undergraduate telemedicine curricula. We searched the Web of Science, PubMed, and Scopus using the keywords such as telemedicine, medical education, and curriculum. Our search was limited to publication dates between January 1, 2000, and February 1, 2020. We elicited the information of the curricula as to their countries, participants, aims or objectives, teaching methods, and evaluation of effectiveness. We also evaluated the quality of the studies using the Joanna Briggs Institute Qualitative Appraisal and Review Instrument. Out of 461 studies, seven articles were selected based on selection criteria for further review. The studies were mostly from the USA. The participant numbers were between seven and 268. There were several modes of delivery but lectures and patient encounters were used mostly. In four studies, the effectiveness was evaluated only by using satisfaction surveys, and the results were satisfactory. A study reported the acquisition and application of skills as a result. There is no well-established telemedicine curriculum in the undergraduate years. The methods vary but the effectiveness of the educational programs does not have a robust evidence base. It is evident that undergraduate medical education needs a curriculum backed by strong scientific data on its effectiveness.
Collapse
|
38
|
Alcocer Alkureishi M, Lenti G, Choo ZY, Castaneda J, Weyer G, Oyler J, Lee WW. Teaching Telemedicine: The Next Frontier for Medical Educators. JMIR MEDICAL EDUCATION 2021; 7:e29099. [PMID: 33878011 PMCID: PMC8086780 DOI: 10.2196/29099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 05/04/2023]
Abstract
The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors. Medical educators are challenged with figuring out how to integrate learners into virtual workflows while teaching and providing patient-centered virtual care. In this viewpoint, we review principles of patient-centered care in the in-person setting, explore the concept of patient-centered virtual care, and advocate for the development and implementation of patient-centered telemedicine competencies. We also recommend strategies for teaching patient-centered virtual care, integrating trainees into virtual workflows, and developing telemedicine curricula for graduate medical education trainees by using our TELEMEDS framework as a model.
Collapse
Affiliation(s)
| | - Gena Lenti
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Zi-Yi Choo
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jason Castaneda
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - George Weyer
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Julie Oyler
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, United States
| |
Collapse
|
39
|
Hassani K, McElroy T, Coop M, Pellegrin J, Wu WL, Janke RD, Johnson LK. Rapid Implementation and Evaluation of Virtual Health Training in a Subspecialty Hospital in British Columbia, in Response to the COVID-19 Pandemic. Front Pediatr 2021; 9:638070. [PMID: 34095023 PMCID: PMC8171666 DOI: 10.3389/fped.2021.638070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/06/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Adoption of virtual health (VH) solutions in healthcare has been challenging; this changed rapidly after implementation of physical distancing measures due to the COVID-19 pandemic. In response to the pandemic, British Columbia's Children's and Women's sub-specialty hospitals rapidly trained and scaled up support to equip staff and clinicians to use VH. Methods: Ninety-minute live online training workshops and frequently updated online support materials were offered for 6 weeks. Training was monitored via feedback collected at training sessions and a brief post-training survey. After training completion, a second survey was circulated to measure utilization outcomes and experiences with VH. Results: Eight hundred and ninety-five participants representing 82% of staff requiring support were trained through 101 sessions; 348 (38.9%) and 272 (30.4%) responses were collected for the monitoring and outcome surveys, respectively. Overall, 89% agreed that training was relevant to their needs; participants indicated average 58.1% (SD = 26.6) and 60.6% (SD = 25.2) increase in knowledge and confidence in VH after training; 90.1% had booked or conducted VH sessions. Increase in confidence was more pronounced in participants with lesser previous exposure to VH, but number of sessions conducted post-training and percentage of successful sessions were independent of previous exposure. For future training and support, participants suggested subject-tailored trainings, asynchronous trainings, and availability of experienced users. Discussion: Training is key to success of VH implementation. Moving forward, core competencies in VH should be developed to support standardization and allow for evaluation and quality improvement. Incorporation of VH training in continuous professional development and onboarding is also highly recommended.
Collapse
Affiliation(s)
- Kasra Hassani
- Child Health British Columbia (BC), Provincial Health Services Authority, Vancouver, BC, Canada
| | - Theresa McElroy
- Child Health British Columbia (BC), Provincial Health Services Authority, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Melissa Coop
- Child Health British Columbia (BC), Provincial Health Services Authority, Vancouver, BC, Canada
| | - Joelle Pellegrin
- Child Health British Columbia (BC), Provincial Health Services Authority, Vancouver, BC, Canada
| | - Wan Ling Wu
- Child Health British Columbia (BC), Provincial Health Services Authority, Vancouver, BC, Canada
| | - Rita D Janke
- Child Health British Columbia (BC), Provincial Health Services Authority, Vancouver, BC, Canada
| | - L Kit Johnson
- Child Health British Columbia (BC), Provincial Health Services Authority, Vancouver, BC, Canada
| |
Collapse
|
40
|
Zhou Y, Diemers AD, Brouwer J, Muntinghe FLH, Duvivier RJ, Pols J, Jaarsma ADC, Bos NA. The influence of mixing international and domestic students on competency learning in small groups in undergraduate medical education. BMC MEDICAL EDUCATION 2020; 20:353. [PMID: 33032578 PMCID: PMC7545927 DOI: 10.1186/s12909-020-02277-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/01/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND Medical curricula are increasingly internationalized, with international students being mixed with domestic students in small group learning. Small group learning is known to foster competency learning in undergraduate medical education, specifically Communication, Collaboration, Leadership, and Professionalism. However, it is unclear what happens with the learning of competencies when international students are introduced in small groups. This study explores if students in international small groups master the competencies Collaboration, Leadership and Professionalism at the same level as students in domestic groups in an undergraduate medical curriculum. METHOD In total, 1215 Students of three academic year cohorts participated in the study. They were divided into four learning communities (LCs), per year cohort, in which tutor groups were the main instructional format. The tutorials of two learning communities were taught in English, with a mix of international and Dutch students. The tutorials of the other two learning communities were taught in Dutch with almost all domestic students. Trained tutors assessed three competencies (Collaboration, Leadership, Professionalism) twice per semester, as 'Not-on-track', 'On-track', or 'Fast-on-track'. By using Chi-square tests, we compared students' competencies performance twice per semester between the four LCs in the first two undergraduate years. RESULTS The passing rate ('On-track' plus 'Fast-on-track') for the minimum level of competencies did not differ between the mixed and domestic groups. However, students in the mixed groups received more excellent performance evaluations ('Fast-on-track') than the students in the homogenous groups of Dutch students. This higher performance was true for both international and Dutch students of the mixed groups. Prior knowledge, age, gender, and nationality did not explain this phenomenon. The effect could also not be explained by a bias of the tutors. CONCLUSION When students are educated in mixed groups of international and Dutch students, they can obtain the same basic competency levels, no matter what mix of students is made. However, students in the mixed international groups outperformed the students in the homogenous Dutch groups in achieving excellent performance scores. Future research should explore if these findings can be explained from differences in motivation, perceived grading or social network interactions.
Collapse
Affiliation(s)
- Yan Zhou
- Institute for Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- Institute for Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasperina Brouwer
- Educational Sciences, Faculty Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Friso L H Muntinghe
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robbert J Duvivier
- Institute for Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Jan Pols
- Institute for Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Debbie C Jaarsma
- Institute for Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nicolaas A Bos
- Institute for Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| |
Collapse
|