P1014 - Primary Care Education During a Global Pandemic: Implementation of Telemedicine

Program Goals:
Facing the COVID-19 pandemic and the need for social distancing, our residency program removed residents from certain clinical settings including the resident continuity clinic. This created an educational 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 video beginning in mid-March. Whenever appropriate, sick and well care visits were completed via virtual encounters preceded by nurse-only visits for vaccines when indicated. Initially attendings performed these visits to develop virtual skills, build provider confidence, and ensure that proper infrastructure was in place. Recognizing that telemedicine represented an important educational opportunity for residents, we later incorporated residents into clinic. Residents were first asked to observe a virtual encounter performed by an attending, and then they were observed conducting a virtual encounter. Residents then conducted encounters independently, precepting with attendings via videoconference (including the family) or by putting the family on hold.

Evaluation:
15 residents participated in telemedicine clinics within the first 3 weeks of initiating this program. 11 respondents from all years of training provided feedback. Residents reported completing 2-5 telemedicine visits per half-day session. When asked about the educational value of a telemedicine clinic session, 82% of residents reported this was similar or more educational as compared to a usual continuity clinic session. Educational benefits included the opportunity to improve phone triage skills and increase experience with a technology that residents expect to use in the future. Educational challenges included feeling “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 via telemedicine now.” Although residents felt challenged by the inefficiency of reading screening tools aloud, by delays due to connectivity problems, and by limited physical exam capabilities, they noted many strengths including improved visit attendance rates and convenience for patients.

Discussion:
Innovative care delivery models are necessary to protect the community and the healthcare workforce while also providing needed medical care and educational opportunities for our residents. As we move forward, we will continue to solicit feedback to effectively meet new and evolving educational needs. We anticipate a role for virtual visits well beyond the COVID-19 pandemic. As such, we will continue to train our residents through virtual visits and will soon be engaging medical students in telemedicine electives. We will continue to identify innovative ways to engage learners in telemedicine and streamline processes for determining which visits are appropriate for a virtual visit.