Primary Care Education During a Global Pandemic: Implementation of Telemedicine

Abstract

Program Goals: Facing the COVID-19 pandemic and the need for social distancing, our residency programremoved residents from certain clinical settings including the resident continuity clinic This created aneducational gap in resident training and dramatically affected the way we deliver healthcare to our patients To facilitate medical care in the safest way possible, our clinic implemented virtual visits via phone and videobeginning in mid-March Whenever appropriate, sick and well care visits were completed via virtualencounters preceded by nurse-only visits for vaccines when indicated Initially attendings performed thesevisits to develop virtual skills, build provider condence, and ensure that proper infrastructure was in place Recognizing that telemedicine represented an important educational opportunity for residents, we laterincorporated residents into clinic Residents were rst asked to observe a virtual encounter performed by anattending, and then they were observed conducting a virtual encounter Residents then conducted encountersindependently, precepting with attendings via videoconference (including the family) or by putting the family on hold Evaluation: 15 residents participated in telemedicine clinics within the rst 3 weeks of initiating thisprogram 11 respondents from all years of training provided feedback Residents reported completing 2-5telemedicine visits per half-day session When asked about the educational value of a telemedicine clinicsession, 82% of residents reported this was similar or more educational as compared to a usual continuityclinic session Educational benets included the opportunity to improve phone triage skills and increaseexperience with a technology that residents expect to use in the future Educational challenges includedfeeling “rushed trying to navigate the technology' and discomfort with an unfamiliar process for precepting All participants reported increased level of comfort with providing care via telemedicine after these sessions,and 91% of residents agreed or strongly agreed with the statement “I feel comfortable with providing care viatelemedicine now ” Although residents felt challenged by the inefficiency of reading screening tools aloud, bydelays due to connectivity problems, and by limited physical exam capabilities, they noted many strengthsincluding improved visit attendance rates and convenience for patients Discussion: Innovative care deliverymodels are necessary to protect the community and the healthcare workforce while also providing neededmedical care and educational opportunities for our residents As we move forward, we will continue to solicitfeedback to effectively meet new and evolving educational needs We anticipate a role for virtual visits wellbeyond the COVID-19 pandemic As such, we will continue to train our residents through virtual visits and willsoon be engaging medical students in telemedicine electives We will continue to identify innovative ways toengage learners in telemedicine and streamline processes for determining which visits are appropriate for avirtual visit