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Pilot program trains residents in telemedicine



Medical residents learned how to effectively perform telemedicine skills for remote patients, while still providing the same quality of care during clinic visits, according to the results of a new pilot program.

Dr. Jenna L. Laughlin, an internist at Christiana Care Health System in Newark, Del

Dr. Jenna L. Laughlin

While telephone visits have been shown to be an effective alternative to face-to-face visits for physicians, residents are not trained to perform telemedicine.

“We have no structured training program on how to teach these residents these skills. We assume that the same skills needed in the clinic are applicable through telephone medicine and we’re not sure about that yet,” Jenna L. Laughlin, DO, said at the annual meeting of the Society of General Internal Medicine.

The pilot study took place at Christiana Care Health System, Wilmington, Del., from October 2016 through December 2018. Nine residents were enrolled in the study, but only six participated.

The objective of the pilot was to demonstrate the feasibility of adding telephone visits into the internal medicine residency practice. This feasibility was measured by templating, scheduling, and supervision, noted Dr. Laughlin, an internist at Christiana Care Health System in Newark, Del. Templating was a term used to describe the designing of the program. For example, the researcher templated 1-hour telephone visit blocks, meaning they designed this structure to integrate into the resident’s training program.

Each resident had 1 hour within the weekly schedule to conduct telephone visits. First-year residents were allowed to do one telephone visit during that hour, second-year residents could do two telephone visits within the hour, and third-year residents could do three telephone visits in that hour.

“There were some challenges associated with scheduling and templating, such as initial schedule templates and a high utilization learning curve,” said Dr. Laughlin, lead author of the study and the program’s leader.

Some didn’t schedule enough telemedicine visits; those residents were assigned to acute clinic visits during the times that they should have been practicing telemedicine.

The program’s second objective was to evaluate the resident experience of scheduled telemedicine visits. This included provider-patient continuity and patient ownership.

The six residents who were surveyed about their experiences said these telephone visits increased their patient ownership and allowed them to build rapport with patients. They said the level of supervision they received was appropriate.

In terms of continuity of care, out the 273 telephone visits scheduled, 179 (65%) were with the patient’s primary care provider and 71 (26.0%) were within the primary care provider’s firm.

“As we build primary care practices in the future, there will be many alternative methods of working with our patients, compared to the traditional face-to-face encounters. I think these are increasingly going to be something that our medical residents need for their future,” Dr. Laughlin said.

The authors reported no conflicts of interest.

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