Multidisciplinary Videoconferencing for Physician Education and Remote Management of Interstitial Lung Disease.

Abstract

Background: The gold standard for interstitial lung disease (ILD) diagnosis is multidisciplinary discussion (MDD); however, access is often limited by geographic barriers, time constraints, and the number of centers with ILD expertise. Objective: To assess the educational and clinical impact of a novel videoconferencing MDD program for the diagnosis and management of ILD. Methods: We performed a retrospective observational study of the Multidisciplinary Interstitial Lung Disease Discussion with Experts Remotely (MILDDER) program, a videoconferencing MDD platform initiated by the Toronto General Hospital in Toronto, Canada. We used anonymized survey data from attendees (trainees and practicing physicians) and referring physicians who attended MILDDER between 2018 and 2023. Self-reported ILD confidence before and after MILDDER participation and general program satisfaction were assessed using a 10-point Likert scale. ILD confidence questions were stratified by clinical practice experience. Wilcoxon signed-rank testing for paired data was used to determine statistical significance in the subgroup that completed a MILDDER semester (bimonthly sessions for 6 mo). Written survey responses were assessed qualitatively and grouped by theme. Clinical outcomes, including patient characteristics, new or changed ILD diagnoses, new investigations requests, and new treatment suggestions, were assessed. Results: Three hundred seventeen attendees and referring physicians completed pre-MILDDER questionnaires. Overall, they reported low confidence in their ability to diagnose and manage ILD. After they attended a MILDDER semester ILD, their confidence increased by a median of 3 to 4 points in the overall group. Among respondents with ⩾5 years of clinical practice experience, there was no change in ILD diagnostic confidence after MILDDER; however, management confidence increased by a median of 2 points. A statistically significant increase in all areas of ILD confidence assessed was noted in the subgroup of 70 participants with complete pre- and post-MILDDER semester surveys. Respondents were generally very satisfied with MILDDER. New or changed ILD diagnoses occurred in 86 (50.6%) presented cases, new investigation requests occurred in 40 (22.7%) cases, and new medications were recommended for 30 (17%) cases. Conclusion: Videoconferencing MDD platforms such as MILDDER are feasible and can be used as a tool for physician education and remote management of ILD.