— LETTERS TO THE EDITOR —

Incorporating Telehealth Into Family Medicine Training: An Emerging Need

Zachary Kosak, MD

Fam Med. 2022;54(4):316-317.

DOI: 10.22454/FamMed.2022.201063

To the Editor

I want to thank Dr Kahn for challenging family medicine residencies to measure their success in meeting the needs of our patients and improving care through the lens of the triple aim.1 Additionally, Dr Kahn highlights the need to incorporate telehealth to fulfill continuity principles for our family medicine residents. This is particularly important in the post-COVID pandemic world. To best support continuity and continue to meet the needs of our patients in the spirit of the triple aim, we need to provide intentional telemedicine training to family medicine residents. Intentional telemedicine training is key to enhancing patient experience, improving outcomes, and reducing waste in the virtual world as well.

COVID-related social distancing to protect patients led to a rapid upscaling of telemedicine services across the United States.2,3 Primary care, specifically family medicine, played a vital role in both expanding services and maintaining the quality of care our patients deserve. Up to 73% of primary care visits could be completed via telemedicine,4 and both patients and providers are highly satisfied with telemedicine visits.5 Providers and patients reported saving time,5 clinical productivity has increased, and waiting list times and clinic no-show rates have decreased in clinics that have incorporated telemedicine services.6

If we expect residents to competently conduct telemedicine visits now and in the future, then we must develop intentional ways to teach trainees how to perform telemedicine effectively. STFM has recently released its telemedicine curriculum to work to address this gap.7 At our residency program, preliminary needs assessment data demonstrated that one-third of residents and faculty did not feel confident that they could properly care for patients in telemedicine encounters at the onset of the pandemic. Interestingly, this was distributed across all levels of training, including attending physicians. Years of experience in practice did not translate into confidence with this new skill. Limited literature exists about interventions to educate family medicine residents on effective telemedicine encounters, but what does exist demonstrates that residents feel more confident after intentional training using telemedicine didactics and telemedicine handouts.8 Using our needs assessment, our residency program is actively developing targeted resources to educate our current interns, residents, and attendings on how to have effective telemedicine encounters. These resources are taking two forms to meet the needs of our adult resident learners as well as experienced faculty physicians: asynchronous materials that can be reaccessed later for review, and the addition of a pocket resource for residents to utilize while performing a telemedicine visit as a quick reference.

Instituting telemedicine education as a pillar of residency education is family medicine’s opportunity to meet the needs of physicians in 2021 and beyond. It promotes the triple aim of enhancing care experiences, improving outcomes, and reducing cost. Telemedicine is critical to ensuring continuity opportunities for our patients and resident trainees. Residency programs must be the change that Dr Kahn wishes to see and prepare the next generation of doctors for the future by providing dedicated and intentional training to residents on telemedicine encounters.

References

  1. Kahn NB Jr. Redesigning family medicine training to meet the emerging health care needs of patients and communities: be the change we wish to see. Fam Med. 2021;53(7):499-505. doi:10.22454/FamMed.2021.897904
  2. Flattau A, Cristallo J, Duggan M, Gbur M, Fabienne Daguilh ML, Selwyn P. Clinical redeployment of an academic family medicine department in an early, severe COVID-19 pandemic in the Bronx, NY. J Am Board Fam Med. 2021;34(3):466-473. doi:10.3122/jabfm.2021.03.200562
  3. Drake C, Lian T, Cameron B, Medynskaya K, Bosworth HB, Shah K. Understanding telemedicine’s “new normal”: variations in telemedicine use by specialty line and patient demographics. Telemed J E Health. Jan 2022:51-59. doi:10.1089/tmj.2021.0041
  4. Jetty A, Jabbarpour Y, Westfall M, Kamerow DB, Petterson S, Westfall JM. Capacity of primary care to deliver telehealth in the United States. J Am Board Fam Med. 2021;34(suppl):S48-S54. doi:10.3122/jabfm.2021.S1.200202
  5. Vosburg RW, Robinson KA. Telemedicine in primary care during the COVID-19 pandemic: provider and patient satisfaction examined. Telemed J E Health. May 17 2021. doi:10.1089/tmj.2021.0174
  6. Murphy RP, Dennehy KA, Costello MM, et al. Virtual geriatric clinics and the COVID-19 catalyst: a rapid review. Age Ageing. 2020;49(6):907-914. doi:10.1093/ageing/afaa191
  7. STFM Telemedicine Curriculum. Society of Teachers of Family Medicine.  Accessed October 7, 2021.  https://www.stfm.org/teachingresources/curriculum/telemedicine/telemedicinecurriculum/#24129
  8. Ha E, Zwicky K, Yu G, Schechtman A. Developing a telemedicine curriculum for a family medicine residency. PRiMER Peer-Rev Rep Med Educ Res. 2020;4(21):21. doi:10.22454/PRiMER.2020.126466

Lead Author

Zachary Kosak, MD

Affiliations: University of Pittsburgh Medical Center (UPMC) Shadyside Family Medicine Residency Program, Pittsburgh, PA

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Kahn NB. Redesigning Family Medicine Training to Meet the Emerging Health Care Needs of Patients and Communities: Be the Change We Wish to See. Fam Med. 2021;53(7):499-505. https://doi.org/10.22454/FamMed.2021.897904.

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